The increase in the cardiodepressant activity and vasopressin concentration in the sella turcica venous blood during vagal afferents stimulation or after angiotensin II infusion

International Nuclear Information System (INIS)

Goraca, A.; Orlowska-Majdak, M.; Traczyk, W.Z.

1996-01-01

It has previously been demonstrated that the cardiodepressant activity is present in the bovine hypothalamic extract and in the fluid incubating the posterior pituitary lobe i n situ . The present study was an attempt to reveal if the cardiodepressant factor and vasopressin were simultaneously released from the pituitary into blood. The samples of venous blood flowing from the sella turcica and, for comparison, from the posterior paw were collected in anesthetized rats. Blood from the sella turcica was collected with a fine cannula inserted into the internal maxillary vein. The concentration of vasopressin in blood plasma was determined by radioimmunoassay and cardiodepressant activity-using a biological test on a spontaneously discharged pacemaker tissue of the right auricle of the right heart atrium. Stimulation of the central ends of the cut vagus nerves or intra-arterial infusion of angiotensin II simultaneously caused an increase in the cardiodepressant activity and vasopressin concentration in the sella turcica venous blood. The cardiodepressant activity and vasopressin concentration was also enhanced to some degree in blood outflowing from the posterior paw. Present results indicate that both vasopressin and the cardiodepressant factor are released into blood from the posterior pituitary lobe. (author). 37 refs, 4 figs

The increase in the cardiodepressant activity and vasopressin concentration in the sella turcica venous blood during vagal afferents stimulation or after angiotensin II infusion

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Goraca, A.; Orlowska-Majdak, M.; Traczyk, W.Z. [Akademia Medyczna, Lodz (Poland). Katedra Fizjologii

1996-12-31

It has previously been demonstrated that the cardiodepressant activity is present in the bovine hypothalamic extract and in the fluid incubating the posterior pituitary lobe {sup i}n situ{sup .} The present study was an attempt to reveal if the cardiodepressant factor and vasopressin were simultaneously released from the pituitary into blood. The samples of venous blood flowing from the sella turcica and, for comparison, from the posterior paw were collected in anesthetized rats. Blood from the sella turcica was collected with a fine cannula inserted into the internal maxillary vein. The concentration of vasopressin in blood plasma was determined by radioimmunoassay and cardiodepressant activity-using a biological test on a spontaneously discharged pacemaker tissue of the right auricle of the right heart atrium. Stimulation of the central ends of the cut vagus nerves or intra-arterial infusion of angiotensin II simultaneously caused an increase in the cardiodepressant activity and vasopressin concentration in the sella turcica venous blood. The cardiodepressant activity and vasopressin concentration was also enhanced to some degree in blood outflowing from the posterior paw. Present results indicate that both vasopressin and the cardiodepressant factor are released into blood from the posterior pituitary lobe. (author). 37 refs, 4 figs.

Empty Sella Syndrome

Science.gov (United States)

... Publications Definition Empty Sella Syndrome (ESS) is a disorder that involves the sella turcica , a bony structure at the base of the brain that surrounds and protects the pituitary gland. ESS is often discovered during radiological imaging tests ...

Review of empty sella syndrome and its surgical management

African Journals Online (AJOL)

Wael Fouad

2011-08-19

Aug 19, 2011 ... Abstract Introduction: Empty sella syndrome (ESS) is a condition in which the sella turcica is par- ..... previous surgery, radiotherapy, or medical treatment for ... sella that appeared large and filled with CSF extending down-.

Sella size and jaw bases - Is there a correlation???

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Neha

2016-01-01

Full Text Available Introduction: Sella turcica is an important cephalometric structure and attempts have been made in the past to correlate its dimensions to the malocclusion. However, no study has so far compared the size of sella to the jaw bases that determine the type of malocclusion. The present study was undertaken to find out any such correlation if it exists. Materials and Methods: Lateral cephalograms of 110 adults consisting of 40 Class I, 40 Class II, and 30 Class III patients were assessed for the measurement of sella length, width, height, and area. The maxillary length, mandibular ramus height, and body length were also measured. The sella dimensions were compared among three malocclusion types by one-way ANOVA. Pearson correlation was calculated between the jaw size and sella dimensions. Furthermore, the ratio of jaw base lengths and sella area were calculated. Results and Conclusion: Mean sella length, width and area were found to be greatest in Class III, followed by Class I and least in Class II though the results were not statistically significant. 3 out of 4 measured dimensions of sella, correlated significantly with mandibular ramus and body length each. However, only one dimension of sella showed significant correlation with maxilla. The mandibular ramus and body length show a nearly constant ratio to sella area (0.83–0.85, 0.64–0.65, respectively in all the three malocclusions. Thus, mandible has a definite and better correlation to the size of sella turcica.

Reflections on imaging diagnosis of sella masses

International Nuclear Information System (INIS)

Hernandez Yero, Jose Arturo; Jorge Gonzalez, Raquel

2005-01-01

Some reflections were made on imaging diagnosis of sella masses, specifying some characteristics of the main sella masses and their appearance in magnetic resonance imaging. The purpose was to call the attention on this important issue on the basis that modern imaging advances offer very useful distinctive elements in the diagnosis of a group of masses located in the sella turcica region. The paper underlined details of signal intensity in pituitary adenomas, craniopharyngiomas, Rathkes pouch cysts, hypophyseal hyperplasia and the so-called empty sella syndrome, among other causes of anatomical changes in sella region. It was concluded that magnetic resonance imaging would be the ideal method for a better diagnosis of sella masses, but if this technique was not available, then contrast-enhanced tomography would be useful in under 2 mm views. The importance of a multidisciplinary team of clinicians, endocrinologists, imaging specialists, neurosurgeons and anatomy pathologists to reach more accurate diagnosis and better therapeutic results was stressed

Empty sella syndrome presenting as panhypopituitarism in a child

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Sharmin Jahan

2016-08-01

Full Text Available Empty Sella refers to the absence or relative absence of the pituitary gland on radiologic imaging of the Sella turcica. This is usually an incidental finding, and as few as 10% patients presents with Hypopituitarism. The authors report a 13.5-year-old boy who presei1ted with short stature and absence of signs of pubertal onset. Hormonal assay showed panhypopi­tuitarism. X-ray left wrist joint showed delayed bone age and finally MRl of the brain revealed empty Sella. Growth hormone replacement therapy was started to increase the height. The boy is now on regular follow up to monitor response to treatment.

[Primary hypothyroidism associated with empty sella turcica and hypopituitarism].

Science.gov (United States)

Milosević, Maja; Stojanović, Milos; Nesović, Milica

2005-01-01

Empty sella syndrome is a rather frequent neuroradiological finding in the general population and can be associated with hypopituitarism. Examinations reveal low pituitary hormone levels and lack of response to stimuli. Most patients suffer from central hypothyroidism as part of pituitary insufficiency. Primary hypothyroidism is a rare finding in these patients. We present 3 patients: one female and two male, suffering from complete hypopituitarism, as part of the empty sella syndrome diagnosed due to low concentrations of all pituitary hormones, elevated TSH and low thyroid hormones. TRH, LHRH, ACTH and ITT tests, as well as IGF1 have confirmed hypopituitarism and primary hypothyroidism. CT and NMR in all three patients showed empty sella without a tumor in it. The diagnosis of primary hypothyrodism in the first patient was made before hypopituitarism has taken place, or at the same time in the second patient, whereas in the third patient it was diagnosed twenty years later. In two patients anti-TPO and anti-Tg antibody levels were high, and in the third patient they were not elevated. It can be assumed that the etiology of primary hypothyrodism in all three patients was of autoimmune origin, which caused thyroid hypofunction. High level of TSH in all three patients and especially in the patient whose hypopituitarism was diagnosed twenty years later, showed presence of thyrotrophic cells in the pituitary. Evaluation of the hypothalamic-pituitary-thyroid axis was carried out during the complete substitution therapy of hypopituitarism. Diagnosing primary hypothyroidism associated with hypopituitarism helps improving the knowledge on empty sella syndrome and points to different clinical syndromes characterized by lack of mixoedema, although approach to therapy is the same for both primary and central hypothyroidism.

Magnetic resonance imaging finding of empty sella in obesity related idiopathic intracranial hypertension is associated with enlarged sella turcica

Energy Technology Data Exchange (ETDEWEB)

Ranganathan, Sudarshan; Lee, Sang H.; Checkver, Adam; Sklar, Evelyn; Danton, Gary H. [University of Miami, Department of Radiology, Miami, FL (United States); Lam, Byron L. [University of Miami, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, FL (United States); Alperin, Noam [University of Miami, Department of Radiology, Miami, FL (United States); University of Miami Leonard M. Miller School of Medicine, Department of Radiology, Professional Arts Center, Miami, FL (United States)

2013-08-15

Empty sella in MRI is an important finding associated with idiopathic intracranial hypertension (IIH). This study assesses the sensitivity and reproducibility of several morphological measures of the sella and pituitary gland to identify the measure that best differentiates IIH from controls. Additionally, the study assesses reversal in gland compression following treatment. Sagittal 3D-T1W sequence with 1 mm isotropic resolution was obtained from ten newly diagnosed IIH patients and 11 matched healthy controls. Follow-up MRI scans were obtained from eight patients at 1-week post-lumbar puncture and acetazolamide treatment. 1D and 2D measures of absolute and normalized heights and cross-sectional areas of the gland and sella were obtained to identify the measure that best differentiates IIH patients and controls. Overall area-based measurements had higher sensitivity than length with p < 0.0001 for sella area compared with p = 0.004 for normalized gland height. The gland cross-sectional areas were similar in both cohorts (p = 0.557), while the sella area was significantly larger in IIH, 200 {+-} 24 versus 124 {+-} 25 mm{sup 2}, with the highest sensitivity and specificity, 100 % and 90.9 %, respectively. Absolute gland area was the most sensitive measure for assessing post treatment changes, with 100 % sensitivity and 50 % specificity. Average post-treatment gland area was 18 % larger (p = 0.016). Yet, all eight patients remained within the empty sella range based on a normalized gland area threshold of 0.41. Sellar area is larger in IIH, and it demonstrated highest sensitivity for differentiating IIH from control subjects, while absolute gland area was more sensitive for detecting post treatment changes. (orig.)

Primary hypothyroidism associated with empty sella turcica and hypopituitarism

OpenAIRE

Milošević Maja; Stojanović Miloš; Nešović Milica

2005-01-01

Introduction Empty sella syndrome is a rather frequent neuroradiological finding in the general population and can be associated with hypopituitarism. Examinations reveal low pituitary hormone levels and lack of response to stimuli. Most patients suffer from central hypothyroidism as part of pituitary insufficiency. Primary hypothyreoidism is a rare finding in these patients. Case report We present 3 patients: one female and two male, suffering from complete hypopituitarism, as part of the em...

Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery.

Science.gov (United States)

Sasagawa, Yasuo; Hayashi, Yasuhiko; Tachibana, Osamu; Oishi, Masahiro; Fukui, Issei; Iizuka, Hideaki; Nakada, Mitsutoshi

2017-08-01

To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients. Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging. Twelve patients (15.4%), predominantly female (10 women, p = .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm, p = .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients (p = .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8%, p = .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7%, p = .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (p = .248). Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.

Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

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Soichi Oya

2009-01-01

Full Text Available The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

Magnetic resonance imaging of sella turcica: evaluation of patients with galactorrhea, amenorrhea and hyperprolactinemia

International Nuclear Information System (INIS)

Santos, Alair Augusto Sarmet M.D. dos; Moreira, Denise Madeira; Andreiuolo, Pedro Angelo

1999-01-01

We have selected 135 cases of patients who have done magnetic resonance imaging of sella region, carried out from September, 1991 to August, 1996, who had galactorrhea (G), amenorrhea(A), and hyperprolactinemia (H), isolated or in association. The patients were divided in seven groups, according to the presence of these symptoms and signs. All examinations were made in a private clinic in the city of Rio de Janeiro, Brazil. Correlating these patients with the results of the magnetic resonance images, we found 57 micro adenomas, 31 normal examinations, 22 macro adenomas, 11 pituitary hyperplasias, 7 empty sella and 7 cases included in other aspects. The micro adenoma predominated in groups 1 (GAH), 2 (GH), 3 (HA) and 5 (H), that is, in all groups whose patients had hyperprolactinemia. In macro adenomas, a bright signal on T 1-weighted images indicates pituitary apoplexy with intratumoral hemorrhage. All in all, the magnetic resonance imaging is excellent method to be used in the evaluation of patients with changes in the hypothalamic-pituitary axis. (author)

Empty sella syndrome

International Nuclear Information System (INIS)

Park, Chang Yoon

1973-01-01

The enlarged sella was encountered ordinarily as intrasellar lesion such as pituitary tumor or secondary increased intracranial pressure without certain mechanism. 1951 Busch discovered from his extensive autopsy cases that defects or incomplete attachment of diaphragm sella brings sella enlargement either slightly or moderately enlarged sella with subarachnoid extension. Toennis et al in 1955 discussed enlarged sella due to via infundibular defects or loosely attached stalk area of diaphragm sella from secondary increased intracranial pressure. Du Boulay and others differentiate the entity of none tumor origin of sella enlargement either from raised intracranial pressure or parasella changes, Hence, 'empty sella' was loosely used terminology. We observed following three representative cases in various empty sella syndrome. Case 1: air extended into the sella by pneumoencephalogram. Case 2: chiasma recess herniated into the sella secondary to dilated third ventricle from right thalamic tumor extension. Case 3: enlarged sella firstly mimic intrasella tumor but found intrasella fluid of cerebro-spinal content of extended subarchnoid space into sella. Above changes readily observed by pneumoencephalogram and other means

The morphology of the sella turcica in velocardiofacial syndrome suggests involvement of a neural crest developmental field

DEFF Research Database (Denmark)

Mølsted, Kirsten; Boers, Maria; Kjaer, Inger

2010-01-01

. The deviations were mostly in the posterior part of the dorsum sellae. Individuals with VCFS had increased cranial base angles. The results of this study combined with the information in the literature on the main defects in VCFS (palatal abnormalities, cardiac anomalies, thymic hypoplasia or aplasia......, hypothyroidism, and posterior brain abnormality), suggest involvement of a specific developmental field....

Primary empty sella and GH deficiency: prevalence and clinical implications

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Maurizio Poggi

2012-01-01

Full Text Available Primary empty sella (PES is a particular anatomical condition characterized by the herniation of liquor within the sella turcica. The pathogenesis of this alteration, frequently observed in general population, is not yet completely understood. Recently reports demonstrated, in these patients, that hormonal pituitary dysfunctions, specially growth hormone (GH/insulin-like growth factor (IGF-I axis ones, could be relevant. The aim of this paper is to evaluate GH/IGF-I axis in a group of adult patients affected by PES and to verify its clinical relevance. We studied a population of 28 patients with a diagnosis of PES. In each patient we performed a basal study of thyroid, adrenal and gonadal - pituitary axis and a dynamic evaluation of GH/IGF-I after GH-releasing hormone (GHRH plus arginine stimulation test. To evaluate the clinical significance of GH/IGF-I axis dysfunction we performed a metabolic and bone status evaluation in every patients. We found the presence of GH deficit in 11 patients (39.2 %. The group that displayed a GH/IGF-I axis dysfunction showed an impairment in metabolic profile and bone densitometry. This study confirms the necessity to screen the pituitary function in patients affected by PES and above all GH/IGF-I axis. Moreover the presence of GH deficiency could be clinically significant.

Aspergillosis of the sphenoid sinus simulating a pituitary tumor

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Larranaga, J.; Fandino, J.; Gomez-Bueno, J.; Botana, C.; Rodriguez, D.; Gonzalez-Carrero, J.

1989-09-01

Sphenoidal aspergillosis is an unusual cause of sella turcica enlargement. Pituitary abscess secondary to Aspergillus had been reported. In the present case, a woman with sphenoid sinus aspergillosis mimiced a pituitary tumor. This patient survived her infection with intact pituitary function following a transsphenoidal approach. No postoperative amphotericine-B and 5-fluorocytosine were necessary. CT scan revealed a mass occupying the sphenoid sinus extending to the sella turcica. Factors that should alert the clinican to the presence of a sphenoidal and pituitary abscess in a patient with sella turcica enlargement are prior episodes of sinusitis, meningitis and immunosuppression and, as in the present case, hyperglycemia. (orig.).

Diagnostic significance of roeitgenography in hyperprolactinemia

International Nuclear Information System (INIS)

Vejnberg, Eh.G.; Vepkhvadze, R.Ya.; Kapanadze, B.B.; Sabakhtarashvili, M.A.; Gorgoshidze, B.V.; Kvachadze, M.N.; Sepiashvili, A.O.

1984-01-01

Altogether 87 patients with hyperprolactinemia were examined by roentgenography of the skull with sella turcica, tomography of sella turcica, pneumopelvigraphy, roentgeno- and thermomammography. Prolactin-secreting hypophyseal macro-or microadenoma was found in 17 patients. A high informative value of roentgenoradiological examination of such patients was established which facilitates correct and early diagnosis as well as a choice of appropriate therapeutic tactics

Long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children with cleft lip with or without palate.

Science.gov (United States)

Honda, Aya; Baba, Yoshiyuki; Ogawa, Takuya; Suzuki, Shoichi; Moriyama, Keiji

2013-03-01

Objective : To evaluate the long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children having cleft lip with or without cleft palate. Patients : Eight Japanese patients with cleft lip with or without cleft palate aged 9.3 to 13.1 years. Measures : The maxillary and mandibular positions before (T0), immediately after (T1), and 1, 3, and 5 years after distraction osteogenesis (T2, T3, and T4, respectively) measured on cephalograms superimposed at the sella turcica with the Frankfort horizontal plane as the horizontal reference. The anterior nasal spine (x, y), pogonion (x), and menton (y) were used for linear measurements, and sella turcica-nasion-point A, sella turcica-nasion-point B, and point A-nasion-point B angles were used for angular measurements. Results : The mean horizontal maxillary advancement (anterior nasal spine [x]) was 12.3 mm during T0 to T1, but -2.7, -1.1, and -0.1 mm of the posttreatment changes were observed during T1 to T2, T2 to T3, and T3 to T4, respectively. Anterior nasal spine (y) shifted 2.3 mm downward during T0 to T1, and further downward changes were observed during T1 to T2 and T2 to T3 (P < .05). Pogonion (x) did not show distinct changes due to individual variance, but menton (y) shifted downward from T1 to T4. Sella turcica-nasion-point A significantly decreased during T1 to T2 and T2 to T3 but not during T3-T4. Point A-nasion-point B significantly decreased only during T2 to T3, and sella turcica-nasion-point B did not show any distinct change. Conclusions : There was no further maxillary advancement after distraction osteogenesis in the growing children with cleft lip with or without cleft palate. Therefore, long-term observation and management of occlusion in case of the mandibular growth pattern are important.

Magnetic resonance imaging of sella turcica: evaluation of patients with galactorrhea, amenorrhea and hyperprolactinemia; Ressonancia magnetica da sela turca: avaliacao de pacientes com galactorreia, amenorreia e hiperprolactinemia

Energy Technology Data Exchange (ETDEWEB)

Santos, Alair Augusto Sarmet M.D. dos [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Dept. de Radiologia; Moreira, Denise Madeira [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia; Andreiuolo, Pedro Angelo [Beneficencia Portuguesa de Niteroi, RJ (Brazil). Servico de Radiologia Santa Cruz Scan

1999-08-01

We have selected 135 cases of patients who have done magnetic resonance imaging of sella region, carried out from September, 1991 to August, 1996, who had galactorrhea (G), amenorrhea(A), and hyperprolactinemia (H), isolated or in association. The patients were divided in seven groups, according to the presence of these symptoms and signs. All examinations were made in a private clinic in the city of Rio de Janeiro, Brazil. Correlating these patients with the results of the magnetic resonance images, we found 57 micro adenomas, 31 normal examinations, 22 macro adenomas, 11 pituitary hyperplasias, 7 empty sella and 7 cases included in other aspects. The micro adenoma predominated in groups 1 (GAH), 2 (GH), 3 (HA) and 5 (H), that is, in all groups whose patients had hyperprolactinemia. In macro adenomas, a bright signal on T 1-weighted images indicates pituitary apoplexy with intratumoral hemorrhage. All in all, the magnetic resonance imaging is excellent method to be used in the evaluation of patients with changes in the hypothalamic-pituitary axis. (author)

Empty sella syndrome secondary to intrasellar cyst in adolescence.

Science.gov (United States)

Raiti, S; Albrink, M J; Maclaren, N K; Chadduck, W M; Gabriele, O F; Chou, S M

1976-09-01

A 15-year-old boy had growth failure and failure of sexual development. The probable onset was at age 10. Endocrine studies showed hypopituitarism with deficiency of growth hormone and follicle-stimulating hormone, an abnormal response to metyrapone, and deficiency of thyroid function. Luteinizing hormone level was in the low-normal range. Posterior pituitary function was normal. Roentgenogram showed a large sella with some destruction of the posterior clinoids. Transsphenoidal exploration was carried out. The sella was empty except for a whitish membrane; no pituitary tissue was seen. The sella was packed with muscle. Recovery was uneventful, and the patient was given replacement therapy. On histologic examination,the cyst wall showed low pseudostratified cuboidal epithelium and occasional squamous metaplasia. Hemosiderin-filled phagocytes and acinar structures were also seen. The diagnosis was probable rupture of an intrasellar epithelial cyst, leading to empty sella syndrome.

Metastatic Mantle Cell Lymphoma to the Pituitary Gland: Case Report and Literature Review

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Arthur Wang

2016-01-01

Full Text Available We present an unusual case of a metastatic mantle cell lymphoma (MCL to the pituitary gland. The patient had a known history of MCL for which she previously received chemotherapy. She presented with new-onset diplopia and confusion, and reported a history of progressive vision blurriness associated with headache, nausea, and vomiting. MRI of the brain showed an enhancing lesion within the sella turcica involving the cavernous sinuses bilaterally, extending into Meckel's cave on the left, and abutting the optic nerves bilaterally. Following surgical excision, histopathology revealed the tumor to be a MCL. Metastatic pituitary tumors are rare and have been estimated to make up 1% of tumors discovered in the sellar region. The two most common secondary metastatic lesions to the sella are breast and lung carcinoma followed by prostate, renal cell, and gastrointestinal carcinoma. Metastatic lymphoma to the pituitary gland is especially rare and is estimated to constitute 0.5% of all metastatic tumors to the sella turcica. To our knowledge, this is the first reported case of MCL metastasizing to the pituitary gland.

Shift of the pituitary stalk in intrasellar pituitary adenomas

International Nuclear Information System (INIS)

Ito, Jusuke; Tokiguchi, Susumu; Nakamori, Akitoshi; Watanabe, Akira; Yokoyama, Motoharu.

1982-01-01

Fifty-one patients from a group of 344 patients undergoing the evaluation of intrasellar or parasellar tumors were diagnosed on CT as having an intrasellar pituitary adenoma. Axial transverse sections were performed at -10 0 to Reid's basal line, using 1.5-mm-thick slices and sagittal and coronal reformation. Of these 51 patients, 17 showed a shift of the pituitary stalk. The area where a tumor was thought to be located within the sella turcica on preoperative CT became defective on CT after transsphenoidal surgery in all cases. Histological verification was obtained in all cases. Also, the shift of the pituitary stalk was normalized or markedly improved after surgery in all cases. In functioning tumors, all cases except two showed an endocrinologically normal state or a marked improvement after transsphenoidal surgery. On the basis of the above-mentioned facts, it was concluded that the shift of the pituitary stalk in intrasellar pituitary adenomas indicated the evidence of a mass and its location in the sella turcica. However, a shift of the pituitary stalk was also observed under other conditions, such as empty sella and tuberculum sellae meningioma, and so it is not a pathognomonic finding in intrasellar pituitary adenomas. (author)

The primary empty sella in children and its significance

International Nuclear Information System (INIS)

Tokiguchi, Susumu; Tsuchiya, Toshiaki; Ito, Jusuke

1983-01-01

The primary empty sella has been thought to be rare in children; only a few children have been described in the literature. The majority of such cases have been associated with congenital anomalies, optic atrophies, or cerebrospinal fluid rhinorrheas. We now report four cases of the primary empty sella in children. Two of the patients(Case 1 and Case 3) were prepubescent and had primary generalized epilepsy, while Case 2 and Case 4 complained of attacks of vascular headache and peri-orbital pain respectively. None of them showed any clinical evidence of endocrine disturbance. Ophthalmological examination revealed no abnormalities. The association of the primary empty sella with such disorders as primary epilepsy, attacks of vascular headache, and peri-orbital pain were thought to be almost certainly coincidental; the possibility was suggested that the empty sella might be present in children as an anatomical variant or as an acquired process in a certain percentage of them. (author)

Sellar tumors; Tumoren der Sellaregion

Energy Technology Data Exchange (ETDEWEB)

Weber, M.A.; Essig, M. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Abt. Radiologie; Zoubaa, S. [GSF - Forschungszentrum fuer Gesundheit und Umwelt, Neuherberg, Muenchen (Germany). Abt. Neuropathologie; Politi, M.; Grunwald, I. [Universitaetsklinikum Saarland, Homburg (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie

2007-06-15

Because of the complex anatomy, examination of the sella turcica and hypophysis needs a dedicated MR sequence protocol. Not every sellar lesion is a pituitary adenoma. Thus, this review article summarizes the most frequently encountered intra-, supra-, and parasellar tumors and lesions. Differential diagnoses comprise besides adenoma among others craniopharyngioma, meningioma, glioma, germinoma, hamartoma, aneurysm, trigeminal schwannoma, pituitary carcinoma, chordoma, metastasis, infection, and empty sella. Characteristic imaging findings are presented and correlated to micro- and macro-pathology. (orig.)

description of the normal variants of the anatomical shapes of the ...

African Journals Online (AJOL)

Emmanuel Ameh

the types of floor of the sella turcica in relation to sex of the subjects studied, the difference in frequency of ..... and brain. The skull (Volume 1, Book 1). Mosby,. St. Louis. 1971; 359-405. 4. Jones RM ... Physics, biology and protection. Mosby, St.

Variability of the cranial and dental phenotype in Williams syndrome.

Science.gov (United States)

Axelsson, Stefan

2005-01-01

Williams syndrome (WS) is a rare congenital disorder involving the cardiovascular system, connective tissue, and the central nervous system, resulting in mild to moderate mental retardation, a specific cognitive profile, unique personality characteristics, distinctive facial features, and cardiovascular disease. The majority of individuals with a clinical diagnosis of WS have a contiguous gene deletion at chromosome 7 (7q11.23). Physical features include characteristic facial features with full prominent cheeks, wide mouth, long philtrum, small nose with depressed nasal bridge, heavy orbital ridges, medial eyebrow flare, dental abnormalities, hoarse voice, growth retardation, and cardiovascular abnormalities (most commonly supravalvular aortic stenosis and/or peripheral pulmonary artery stenosis). The cognitive profile is distinctive, consisting of strengths in auditory memory, language, and face-processing, but extreme weakness in visuospatial, numerical and problem-solving abilities. Neurological studies have identified a significantly decreased brain volume in adult individuals with WS with relatively normal development of the limbic, frontal and cerebellar structures. The aims were to analyse the neurocranium, the craniofacial region, and the dentition in a well defined Norwegian group of individuals with WS. In order to accomplish this, normative cephalometric standards for the neurocranium, including the cranial base and the sella turcica, were established for Norwegian males and females from 6 to 21 years of age, using lateral radiographic cephalograms from the Oslo University Craniofacial Growth Archive. The study material comprised radiographic lateral cephalograms, orthopantomograms and dental casts from 62 individuals with WS ranging from 4 to 44 years. The lateral cephalograms, orthopantomograms and dental casts were analysed using standard methods reported in the literature. Neurocranium: The results from the cephalometric analyses showed that the size

Determinants of Virulence and In Vitro Development Colocalize on a Genetic Map of Setosphaeria turcica.

Science.gov (United States)

Mideros, Santiago X; Chung, Chia-Lin; Wiesner-Hanks, Tyr; Poland, Jesse A; Wu, Dongliang; Fialko, Ariel A; Turgeon, B Gillian; Nelson, Rebecca J

2018-02-01

Generating effective and stable strategies for resistance breeding requires an understanding of the genetics of host-pathogen interactions and the implications for pathogen dynamics and evolution. Setosphaeria turcica causes northern leaf blight (NLB), an important disease of maize for which major resistance genes have been deployed. Little is known about the evolutionary dynamics of avirulence (AVR) genes in S. turcica. To test the hypothesis that there is a genetic association between avirulence and in vitro development traits, we (i) created a genetic map of S. turcica, (ii) located candidate AVRHt1 and AVRHt2 regions, and (iii) identified genetic regions associated with several in vitro development traits. A cross was generated between a race 1 and a race 23N strain, and 221 progeny were isolated. Genotyping by sequencing was used to score 2,078 single-nucleotide polymorphism markers. A genetic map spanning 1,981 centimorgans was constructed, consisting of 21 linkage groups. Genetic mapping extended prior evidence for the location and identity of the AVRHt1 gene and identified a region of interest for AVRHt2. The genetic location of AVRHt2 colocalized with loci influencing radial growth and mycelial abundance. Our data suggest a trade-off between virulence on Ht1 and Ht2 and the pathogen's vegetative growth rate. In addition, in-depth analysis of the genotypic data suggests the presence of significant duplication in the genome of S. turcica.

Case Study

African Journals Online (AJOL)

IndexCopernicus Portal System

The medium- term evolution was marked by prolonged amenorrhea, fatigue and apathy. In the light of this clinical picture, Sheehan's syndrome was suspected and confirmed by a pituitary and cerebral MRI which showed an empty sella turcica (figure1). Hormone profiles including cortisol, plasma ACTH, thyroid hormones,.

Empty sella syndrome associated with hormone deficiency in adults

International Nuclear Information System (INIS)

Oleaga, L.; Paja, M.; Goni, F.; Grande, J.; Grande, D.; Merino, M.; Delgado, A.

1999-01-01

The objective of this study was to correlate the magnetic resonance (MR) images in patients with hormone deficiencies with the clinical data and the hormonal status. We studied 11 cases ef empty sella with different peripheral pituitary deficiencies. Hormone levels were determined according to standard laboratory methods. All the patients underwent MR imaging. The studies were carried out with a 1 Tesla superconducting magnet, using the cranial cavity for transmission and reception. Segittal and coronal T1-weighted spin-echo sequences (TR/TE: 600/15 ms), axial T2-weighted spin-echo sequences (TR/TE: 3,500/19/93 ms) and gadolinium-enhanced (=.2 cc/kg body weight) sagital and coronal T1-weighted spin-echo sequences (TR/TE: 600/15 ms) were employed. Six of the patients presented partial or total hypopituitarism associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH); there was one case of panhypopituitarism without SIADH and four cases of primary hypothyroidism, there of which were associated with pituitary deficiency, MR imaging revealed five cases of partially empty sella with residual pituitary gland on the sella floor and six cases in which the sella was completely empty. This study also identified six cases of normally situated neurohypophysis, another four in which the neurohypophysis could not be identified and one case of ectopic neurohypophysis. MR imaging is the technique of choice in the study of abnormal hypothalamic-pituitary activity. Empty and partially empty sella should be included among the frequent causes of hypopituitarism, although there is no clear relationship between the degree of adenohypophyseal insufficiency and the degree of atrophy of this system as viewed in MR images. In some cases, this entity may be the radiological sign of a phase in the development of an autoimmune inflammatory process involving the pituitary gland. (Author) 16 refs

[Etiological diagnosis of central diabetes insipidus: about 41 cases].

Science.gov (United States)

Chaker, Fatma; Chihaoui, Melika; Yazidi, Meriem; Slimane, Hedia

2016-01-01

The occurrence of polyuria-polydipsia syndrome with hypotonic urine requires careful diagnostic strategy. This study aims to evaluate diagnostic modalities for central diabetes insipidus. We conducted a retrospective study of 41 cases with central diabetes insipidus (CDI). Data were collected at the Department of Endocrinology, University Hospital La Rabta, Tunis, from 1990 to 2013. We identified the circumstances for detecting CDI, the abnormalities in anterior pituitary assessment and pituitary imaging. CDI occurred in the postoperative period in 20 patients. The average urine 24-hour volume was significantly higher in patients with CDI outside a surgical setting. Water deprivation test was successful in all patients who benefited from it. Outside of neurosurgery, infiltration causes were found in 6 patients and tumor causes were found in 6 patients. CDI was associated with empty sella turcica in 1 case and idiopathic sella turcica in 3 patients. Hypothalamic-pituitary magnetic resonance imaging and anterior pituitary balance sheet are systematic outside pituitary surgery setting and obvious primary polydipsia.

Xanthomatosis, pituitary gland, Magnetic Resonance Imaging, Sella turcica

International Nuclear Information System (INIS)

Jang, Seok Jin; Kim, Eui Jong; Choi, Woo Seok; Park, Bong Jin

2011-01-01

Xanthomatous hypophysitis is a rare inflammatory disorder of the pituitary gland of unknown prevalence that causes pituitary dysfunction and a mass-like lesion. The authors report a case of 40-year-old man with a visual disturbance and a confirmed diagnosis of xanthomatous hypophysitis.

WAJM 29(2) LATEST.pmd

African Journals Online (AJOL)

user1

Pregnancy Associated with Recurrent Acromegaly: A Case Report. Associée à la grossesse avec récurrentes acromégalie: Un ... disorder. Pregnancy is an unusual event in acromegalic females because fertility is often reduced. .... Computed tomography. (CT) scan of brain showed no significant enlargement of sella turcica ...

The basal cell naevus syndrome - radiographic findings in the skull

International Nuclear Information System (INIS)

Stoll, P.; Dueker, J.; Weingart, D.

1986-01-01

Besides uni- and multiocular jaw cysts the Gorlin Goltz syndrome shows other characteristic radiographic findings which help to ensure diagnosis. These are particularly calcification of the falx cerebri and a so called ''bridging'' between processus clinoideus anterior and posterior of the sella turcica. The importance of early diagnosis is stressed. (orig.) [de

Basal cell naevus syndrome - radiographic findings in the skull

Energy Technology Data Exchange (ETDEWEB)

Stoll, P.; Dueker, J.; Weingart, D.

1986-09-01

Besides uni- and multiocular jaw cysts the Gorlin Goltz syndrome shows other characteristic radiographic findings which help to ensure diagnosis. These are particularly calcification of the falx cerebri and a so called ''bridging'' between processus clinoideus anterior and posterior of the sella turcica. The importance of early diagnosis is stressed.

The neuroradiological study of craniopharyngiomas; A comparison with non-functioning pituitary macroadenomas

Energy Technology Data Exchange (ETDEWEB)

Oikawa, Susumu; Takemae, Toshiki; Kobayashi, Shigeaki (Shinshu Univ., Matsumoto, Nagano (Japan). Faculty of Medicine)

1992-06-01

The neuroradiological manifestations of 10 surgically verified craniopharyngiomas are retrospectively studied and compared with those of 8 non-functioning pituitary macroadenomas. The saucer-like appearance of the sella turcica on a craniogram was noted in 2 of the 10 craniopharyngiomas and in 2 of the 8 pituitary adenomas. A ballooning of the sella turcica was observed in one of the 10 craniopharyngiomas and in 5 of the 8 pituitary adenomas. Calcification on CT scan was presented in only 5 craniopharyngiomas. On a plain CT scan, no craniopharyngioma manifested any high-density mass except calcification. Four pituitary adenomas showed a slightly high density, though. A cystic lesion was revealed in all the craniopharyngiomas and in 4 pituitary adenomas. All the craniopharyngiomas except for one intrasellar type and all the pituitary adenomas were enhanced with a contrast medium. The solid portion in one craniopharyngioma and in one pituitary adenoma was high-intensity on T[sub 1]-weighted MRI. The cystic portion in 4 craniopharyngiomas and in 2 pituitary adenomas manifested a high intensity on a T[sub 1]-weighted image. A normal pituitary gland located on the floor of the sella was disclosed in all the craniopharyngiomas on a sagittal T[sub 1]-weighted image; however in all the pituitary adenomas, no normal pituitary gland was found at least not on the floor of the sella. The presence of a normal pituitary gland on the sellar floor on sagittal T[sub 1]-weighted MRI may be a new differential diagnostic point between craniopharyngioma and pituitary macroadenoma. Calcification, cystic formation, and density on a plain CT scan seem to be useful evidence for diagnosis. (author).

The neuroradiological study of craniopharyngiomas

International Nuclear Information System (INIS)

Oikawa, Susumu; Takemae, Toshiki; Kobayashi, Shigeaki

1992-01-01

The neuroradiological manifestations of 10 surgically verified craniopharyngiomas are retrospectively studied and compared with those of 8 non-functioning pituitary macroadenomas. The saucer-like appearance of the sella turcica on a craniogram was noted in 2 of the 10 craniopharyngiomas and in 2 of the 8 pituitary adenomas. A ballooning of the sella turcica was observed in one of the 10 craniopharyngiomas and in 5 of the 8 pituitary adenomas. Calcification on CT scan was presented in only 5 craniopharyngiomas. On a plain CT scan, no craniopharyngioma manifested any high-density mass except calcification. Four pituitary adenomas showed a slightly high density, though. A cystic lesion was revealed in all the craniopharyngiomas and in 4 pituitary adenomas. All the craniopharyngiomas except for one intrasellar type and all the pituitary adenomas were enhanced with a contrast medium. The solid portion in one craniopharyngioma and in one pituitary adenoma was high-intensity on T 1 -weighted MRI. The cystic portion in 4 craniopharyngiomas and in 2 pituitary adenomas manifested a high intensity on a T 1 -weighted image. A normal pituitary gland located on the floor of the sella was disclosed in all the craniopharyngiomas on a sagittal T 1 -weighted image; however in all the pituitary adenomas, no normal pituitary gland was found at least not on the floor of the sella. The presence of a normal pituitary gland on the sellar floor on sagittal T 1 -weighted MRI may be a new differential diagnostic point between craniopharyngioma and pituitary macroadenoma. Calcification, cystic formation, and density on a plain CT scan seem to be useful evidence for diagnosis. (author)

New medical application: nuclear scattering radiography

International Nuclear Information System (INIS)

Saudinos, J.

1977-01-01

Nuclear scattering of 1 GeV protons is used to obtain three dimensional radiographies with a volume resolution of about 1 mm 3 . The information is different from the one given by X-ray radiographies and in particular one may get radiographies of the hydrogen included in objects. Results on a vertebral column and a 'sella turcica' are presented [fr

MRI and MR angiography of persistent trigeminal artery

International Nuclear Information System (INIS)

Piotin, M.; Miralbes, S.; Cattin, F.; Marchal, H.; Amor-Sahli, M.; Moulin, T.; Bonneville, J.F.

1996-01-01

We describe the MRA and MR angiography (MRA) features of persistent trigeminal artery (PTA) found incidentally in eight patients, with special attention to its origin, site and course. The different patterns of posterior communicating arteries were also noted. The PTA were shown on sagittal, coronal and axial MRI and on MRA. In four cases, the PTA arose from the lateral aspect of the intracavernous internal carotid artery, ran caudally, passing round the bottom of the dorsum sellae to join the basilar artery. In the other four cases, it arose from the medial aspect, ran caudally through the sella turcica and pierced the dorsum sellae to join the basilar artery. The posterior communicating arteries were present unilaterally in five cases and bilaterally in one, and absent bilaterally in two. Identification of a PTA with a trans-sellar course is crucial if a trans-sphenoidal surgery is planned. (orig.). With 3 figs

Pathology galactorrhea. Dynamic tests of prolactin secretion evaluation and the adenohypophyseal functional reserve

International Nuclear Information System (INIS)

Oliveira, B.C. de.

1979-01-01

Stimulus and supression tests of prolactin secretion and reserve evaluation of others hypophyseal trophin in thirty-seven patients, of feminine sex with galactorrhea and twelve normal volunteers with the objective of determinate the validity for etiologic diagnostic of pathologic galactorrhea are described. Simple radiography of brain and sella turcica on anteroposterior incidence and profile followed by plane tomography in all patients with pathological galactorrhea are also presented. (author)

Contrast-enhanced MRI of intrasellar arachnoid cysts: relationship between the pituitary gland and cyst

International Nuclear Information System (INIS)

Nomura, M.; Kanazawa Univ. School of Medicine; Tachibana, O.; Hasegawa, M.; Kohda, Y.; Nakada, M.; Yamashima, T.; Yamashita, J.; Suzuki, M.

1996-01-01

We recently encountered two large intrasellar arachnoid cysts extending to the suprasellar region. The intensity of the cyst contents was identical to that of the cerebrospinal fluid on both T1- and T2-weighted MRI. On contrast-enhanced MRI, the pituitary gland was compressed posteroinferiorly and flattened in the sella turcica. In this report of rare intrasellar arachnoid cysts the discussion is focused on dislocation of the pituitary gland. (orig.)

Extension and origin of parasellar meningiomas. Evaluation on MRI

International Nuclear Information System (INIS)

Hara, Yoshie; Nakamura, Mitsugu; Asada, Masahiro; Tamaki, Norihiko

1997-01-01

We evaluated MRI of forty patients who had histologically confirmed meningiomas around the sella turcica. Coronal section of the spin-echo/fast spin-echo T 1 weighted imaging (with and without GD-DTPA enhancement) were mainly investigated. We precisely examined two points; the location of the bulk of tumor mass, the anatomical relationship between the tumor and the anterior clinoid process, superior orbital fissure, optic nerve, and the internal carotid artery (ICA). Based on MRI findings, we recognized five different tumor origins. Meningiomas originating lateral to the anterior clinoid process never extended medially into the cavernous sinus or the sella turcica, while tumors originating medial to the anterior clinoid process did not migrate laterally beyond the process. Tumors originating from the cavernous sinus tended to invade though the dura into the superior orbital fissure and involved the anterior clinoid process. Based upon the tumor origin and their extension investigated as revealed by MRI, we speculated that the anterior clinoid process and the tough dural folds attached to it (the anterior and posterior petroclinoid ligaments, and the interclinoid ligament) played important roles as barriers against the extension of meningiomas. These dural folds may be the unique part of the dura that most resists invasion of meningiomas from extracavernous regions. Meningiomas originated from the inferomedial surface of the anterior clinoid process may have been misdiagnosed as tuberculum sellae meningiomas; however, the close anatomical relation of the tumor origin and the distal carotid suggests their potential to directly invade the internal carotid artery. (K.H.)

Refraction-contrast bone imaging using synchrotron radiation

International Nuclear Information System (INIS)

Mori, Koichi; Sekine, Norio; Sato, Hitoshi; Shikano, Naoto; Shimao, Daisuke; Shiwaku, Hideaki; Hyodo, Kazuyuki; Oka, Hiroshi

2002-01-01

The X-ray refraction-contrast imaging using synchrotron radiation with some X-ray energies is successfully performed at B120B2 of SPring-8. The refraction-contrast images of bone samples such as human dried proximal phalanx, wrist, upper cervical vertebrae and sella turcica and as mouse proximal femur using the synchrotron X-ray are always better in image contrast and resolution than those of the absorption-contrast images using the synchrotron X-ray and/or the conventional X-ray tube. There is much likeness in the image contrast and resolution of trabeculae bone in the human dried proximal phalanx between X-ray energy of 30 keV at sample-to-film distance of 1 m and those of 40, 50 keV at those of 4,5 m, respectively. High-energy refraction-contrast imaging with suitable sample-to-film distance could reduce the exposure dose in human imaging. In the refraction-contrast imaging of human wrist, upper cervcal vertebrae, sella turcica and mouse proximal femur using the synchrotron X-ray, we can obtain better image contrast and resolution to correctly extract morphological information for diagnosis corresponding to each of the clinical field than those of the absorption-contrast images. (author)

A study on secondary images in panoramic radiograph

International Nuclear Information System (INIS)

Cho, Dai Hee; Kim, Han Pyong

1984-01-01

This study was performed to observe the secondary images and to analyse the relationships between the primary and secondary images in panoramic radiograph. Using the Morita's Panex-EC panoramic x-ray machine and the human dry skull, the author analysed 17 radiographs which were selected from 65 radiographs of the dry skull that attached the radiopaque materials, and the attached regions of the radiopaque materials were the normal anatomical structures which were important and selected as a region for the evaluation of the secondary images effectively. The results were as follows; 1. The cervical vertebrae showed three images. The midline image was the most distorted and less clear, and bilateral images were slightly superimposed over the posterior border of the mandibular ramus. 2. In mandible, the secondary image of the posterior border of the ramus was superimposed on the opposite ramus region, and this image was elongated from the anterior border of the ramus to the lateral side of the posterior border of the ramus. The secondary image of the condyle was observed on the upper area of the coronoid process, the sigmoid notch and the condyle in opposite side. 3. In maxilla, the posterior region of the hard palate showed the secondary image on the lower part of the nasal cavity and the medial wall of the maxillary sinus. 4. The primary images of the occipital condyle and the mastoid process appeared on the same region, and only the secondary image of the occipital condyle was observed symmetrically on the opposite side with similar shape to the primary one. 5. In the cranial base, the anatomical structures of the midsagittal portions like a inferior border of the frontal sinus, sella turcica, inferior border of the sphenoid sinus and inferior border of the posterior part of the occipital bone showed the similar shape between the primary and secondary images symmetrically. 6. The petrous portion of the temporal bone showed the secondary image of the lateral side of

Bony Regeneration of the Sella after Transsphenoidal Pituitary Surgery.

Science.gov (United States)

Yahia-Cherif, Mehdi; Delpierre, Isabelle; Hassid, Sergio; De Witte, Olivier

2016-04-01

The purpose of this study is to demonstrate the possible bony regrowth of the sella after transsphenoidal surgery without any intraoperative sellar reconstruction. Radiologic findings of the sella were reviewed in patients with pituitary tumors treated by transsphenoidal surgery. In 17 patients who had postoperative cranial computed tomography scans, bony regeneration of the sellar floor was evaluated by comparing immediate and late postoperative scans. The bony opening reduction was measured in transverse and sagittal planes. The median bony opening diameter in the transverse plane was 8.8 mm (interquartile range [IQR] 5.7-11.4) on the first scan and 4.2 mm (IQR 0.8-6.8) on the second scan. In the sagittal plane, it was 4.8 mm (IQR 1.8-6.8) on the first scan and 2.9 mm (IQR 1.6-3.9) on the second scan. These changes occurred in a median time of 36 months (IQR 22-42). There was a statistically significant decrease of the bony opening diameters in both the transverse and sagittal planes (P transsphenoidal pituitary surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Schizophernia and empty sella – casual or correlated?

OpenAIRE

Wix-Ramos, Richard Joseph; Capote, Eduardo; Mendoza, Milet; Garcia, Margreth; Ezequiel, Uribe

2011-01-01

Summary A male patient, 44 years old, with schizophrenia which started at the age of 18. At his last follow-up visit, laboratory tests and brain magnetic resonance imaging (MRI) were performed, revealing the presence of a sellar arachnoidocele. To our knowledge, there is only one similar case report of a set of male monozygotic triplets with schizophrenia and empty sella syndrome. High-resolution chromosome analysis found an extra band at chromosome 15p in all the triplets and their father. W...

Genetics of Resistance and Pathogenicity in the Maize/Setosphaeria turcica Pathosystem and Implications for Breeding

Directory of Open Access Journals (Sweden)

Ana L. Galiano-Carneiro

2017-08-01

Full Text Available Northern corn leaf blight (NCLB, the most devastating leaf pathogen in maize (Zea mays L., is caused by the heterothallic ascomycete Setosphaeria turcica. The pathogen population shows an extremely high genetic diversity in tropical and subtropical regions. Varietal resistance is the most efficient technique to control NCLB. Host resistance can be qualitative based on race-specific Ht genes or quantitative controlled by many genes with small effects. Quantitative resistance is moderately to highly effective and should be more durable combatting all races of the pathogen. Quantitative resistance must, however, be analyzed in many environments (= location × year combinations to select stable resistances. In the tropical and subtropical environments, quantitative resistance is the preferred option to manage NCLB epidemics. Resistance level can be increased in practical breeding programs by several recurrent selection cycles based on disease severity rating and/or by genomic selection. This review aims to address two important aspects of the NCLB pathosystem: the genetics of the fungus S. turcica and the modes of inheritance of the host plant maize, including successful breeding strategies regarding NCLB resistance. Both drivers of this pathosystem, pathogen, and host, must be taken into account to result in more durable resistance.

Infrasellar craniopharyngioma: case report

Directory of Open Access Journals (Sweden)

Falavigna Asdrubal

2001-01-01

Full Text Available We report a case of infrasellar craniopharyngioma in a 34 year-old woman who presented with progressive headache and diplopia. Computed tomographic and magnetic resonance images showed a heterogeneous tumor originating from the sphenoid bone with ethmoid sinus and sella turcica extension. A sublabial rhinoseptal transsphenoidal surgery was performed. Craniopharyngiomas with infrasellar development are very rare. Infrasellar craniopharyngioma is uncommon, thirty-five cases has been reported in literature. The embryology, clinical features and radiographic investigation of these tumors are discussed.

X-Ray semiotics of cranial involvement in endocrine diseases

International Nuclear Information System (INIS)

Spuzyak, M.I.; Kramnoj, I.E.; Belaya, L.M.; Tyazhelova, O.V.; Litvinenko, V.M.

1992-01-01

The incidence and type of X-ray semeiotics of the skull involvement were studied in 703 patients with endocrine diseases. Craniorgam analysis involved study of the thickness and structure of the vault bones, shape and size of the skull, status of the sutures, internal plate relief, changes of the base of the skull, of the sella turcica first of all, and facial bone. The characteristic X-ray symprom complexes of the involvement of the skull in some endocrine diseases were distinguished

Tumors in the region of the sella turcica; Tumoren der Sellaregion

Energy Technology Data Exchange (ETDEWEB)

Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostischeund Interventionelle Neuroradiologie, Homburg/Saar (Germany)

2009-07-15

Tumors of the pituitary gland can lead to limitation of hypophysis function (hypophysis insufficiency) or hypersecretion of different hormones (acromegaly, Cushing's syndrome, prolactinoma, TSH-secreting adenoma). The optic chiasma lies in close proximity to the pituitary gland and can be compressed by tumors leading to visual disturbances (bilateral hemianopsia). Tumors can be separated into hormone secreting and hormone inactive tumors, as well as into microadenoma with a diameter <10 mm and macroadenomas >10 mm. A rare group of tumors of the hypophysis region are craniopharyngiomas, meningiomas, germinomas, gliomas, metastases and granulomotous inflammations, such as sarcoidosis and tuberculosis. (orig.) [German] Bei Tumoren der Hypophysenregion kann es zu einer Einschraenkung der Hypophysenfunktion (Hypophyseninsuffizienz) kommen, aber auch zu einem Hypersekretionssyndrom (Akromegalie, Cushing-Syndrom, Prolaktinom, TSH-sezernierendes Adenom). Unmittelbar ueber der Hypophysenregion liegt das Chiasma opticum, wodurch es bei Tumoren der Hypophysenregion zur Beeintraechtigung des Sehens kommen kann, meist als Verschlechterung des Sehfeldes beider Augen nach lateral (bitemporale Hemianopsie). Man unterscheidet hormonaktive und -inaktive Tumoren. Es werden Mikroadenome mit einem Durchmesser bis 10 mm und Makroadenome, die groesser als 10 mm sind, unterschieden. Eine seltenere Gruppe von Tumoren der Hypophysenregion sind die Kraniopharyngeome, Meningeome, Germinome, Gliome, Metastasen und granulomatoese Entzuendungen (Sarkoidose, Tuberkulose). (orig.)

Pituitary stalk compression by the dorsum sellae: possible cause for late childhood onset growth disorders.

Science.gov (United States)

Taoka, Toshiaki; Iwasaki, Satoru; Okamoto, Shingo; Sakamoto, Masahiko; Nakagawa, Hiroyuki; Otake, Shoichiro; Fujioka, Masayuki; Hirohashi, Shinji; Kichikawa, Kimihiko

2006-06-01

The purpose of this study was to evaluate the relationship between pituitary stalk compression by the dorsum sellae and clinical or laboratory findings in short stature children. We retrospectively reviewed magnetic resonance images of the pituitary gland and pituitary stalk for 34 short stature children with growth hormone (GH) deficiency and 24 age-matched control cases. We evaluated the degree of pituitary stalk compression caused by the dorsum sellae. Body height, GH level, pituitary height and onset age of the short stature were statistically compared between cases of pituitary stalk compression with associated stalk deformity and cases without compression. Compression of the pituitary stalk with associated stalk deformity was seen in nine cases within the short stature group. There were no cases observed in the control group. There were no significant differences found for body height, GH level and pituitary height between the cases of pituitary stalk compression with associated stalk deformity and cases without compression. However, a significant difference was seen in the onset age between cases with and without stalk compression. Pituitary stalk compression with stalk deformity caused by the dorsum sellae was significantly correlated with late childhood onset of short stature.

Empty sella syndrome associated with hormone deficiency in adults; Silla turca vacia asociada a disfuncion hormonal en adultos

Energy Technology Data Exchange (ETDEWEB)

Oleaga, L.; Paja, M.; Goni, F.; Grande, J.; Grande, D. [Hospital de Basurto. Bilbao (Spain); Merino, M. [Hospital General Yague (Spain); Delgado, A. [Hospital Marques de Valdecilla. Santander (Spain)

1999-07-01

The objective of this study was to correlate the magnetic resonance (MR) images in patients with hormone deficiencies with the clinical data and the hormonal status. We studied 11 cases ef empty sella with different peripheral pituitary deficiencies. Hormone levels were determined according to standard laboratory methods. All the patients underwent MR imaging. The studies were carried out with a 1 Tesla superconducting magnet, using the cranial cavity for transmission and reception. Segittal and coronal T1-weighted spin-echo sequences (TR/TE: 600/15 ms), axial T2-weighted spin-echo sequences (TR/TE: 3,500/19/93 ms) and gadolinium-enhanced (=.2 cc/kg body weight) sagital and coronal T1-weighted spin-echo sequences (TR/TE: 600/15 ms) were employed. Six of the patients presented partial or total hypopituitarism associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH); there was one case of panhypopituitarism without SIADH and four cases of primary hypothyroidism, there of which were associated with pituitary deficiency, MR imaging revealed five cases of partially empty sella with residual pituitary gland on the sella floor and six cases in which the sella was completely empty. This study also identified six cases of normally situated neurohypophysis, another four in which the neurohypophysis could not be identified and one case of ectopic neurohypophysis. MR imaging is the technique of choice in the study of abnormal hypothalamic-pituitary activity. Empty and partially empty sella should be included among the frequent causes of hypopituitarism, although there is no clear relationship between the degree of adenohypophyseal insufficiency and the degree of atrophy of this system as viewed in MR images. In some cases, this entity may be the radiological sign of a phase in the development of an autoimmune inflammatory process involving the pituitary gland. (Author) 16 refs.

Value of petrosal sinus sampling: coexisting acromegaly, empty sella and meningioma

International Nuclear Information System (INIS)

Yarman, S.; Minareci, Oe.

2004-01-01

Simultaneous occurrence of an intracranial meningioma and a growth hormone (GH)-producing pituitary adenoma is exceedingly rare, as is coexistence of an empty sella and acromegaly. We report all these rare entities in the same patient. We evaluated the role of inferior petrosal sinus sampling for lateralisation of an adenoma in this patient. (orig.)

Value of petrosal sinus sampling: coexisting acromegaly, empty sella and meningioma

Energy Technology Data Exchange (ETDEWEB)

Yarman, S. [Div. of Endocrinology, Metabolism and Nutrition, Istanbul Univ., Istanbul (Turkey); Minareci, Oe. [Dept. of Radiology, Medical Faculty of Istanbul Univ., Istanbul (Turkey)

2004-12-01

Simultaneous occurrence of an intracranial meningioma and a growth hormone (GH)-producing pituitary adenoma is exceedingly rare, as is coexistence of an empty sella and acromegaly. We report all these rare entities in the same patient. We evaluated the role of inferior petrosal sinus sampling for lateralisation of an adenoma in this patient. (orig.)

Schizophernia and empty sella - casual or correlated?

International Nuclear Information System (INIS)

Wix-Ramos, R. J.; Ezequiel, U.; Capote, E.; Mendoza, M.; Garcia, M.

2011-01-01

A male patient, 44 years old, with schizophrenia which started at the age of 18. At his last followup visit, laboratory tests and brain magnetic resonance imaging (MRI) were performed, revealing the presence of a sellar arachnoidocele. To our knowledge, there is only one similar case report of a set of male mono zygotic triplets with schizophrenia and empty sella syndrome. High-resolution chromosome analysis found an extra band at chromosome 15p in all the triplets and their father. We performed a similar evaluation in our patient and his family to compare the results and identify new information on neuro anatomical abnormalities, hormonal alterations or genetic origins of schizophrenia. (authors)

Prolactin-secreting adenoma as part of the multiple endocrine neoplasia--type I (MEN-I) syndrome.

Science.gov (United States)

Levine, J H; Sagel, J; Rosebrock, G; Gonzalez, J J; Nair, R; Rawe, S; Powers, J M

1979-06-01

Two patients presented with the galactorrhea-amenorrhea syndrome. One patient had previously had parathyroid hyperplasia and the other an insulinoma. Preoperative evaluation of each patient revealed hyperprolactinemia and radiological evidence of an abnormal sella turcica. Pituitary adenomas were identified and removed at surgery. Immunostaining techniques confirmed the presence of prolactin-containing cells in both tumors. We propose that prolactin-secreting tumors be considered as part of the MEN-I syndrome, and that patients presenting with the galactorrhea-amenorrhea syndrome be screened and followed sequentially for evidence of other endocrine neoplasia.

Hemorrhagic chondroid chordoma mimicking pituitary apoplexy

Energy Technology Data Exchange (ETDEWEB)

Lee, H.J.; Kalnin, A.J.; Holodny, A.I. [Dept. of Radiology, University Hospital, Newark, NJ (United States); Schulder, M.; Grigorian, A. [Dept. of Neurosurgery, University Hospital, Newark, NJ (United States); Sharer, L.R. [Dept. of Pathology, University Hospital, Newark, NJ (United States)

1998-11-01

We describe a hemorrhagic chondroid chordoma involving the sella turcica with suprasellar extension. The CT and MRI appearances mimiked a hemorrhagic pituitary adenoma. Chondroid chordoma is a variant composed of elements of both chordoma and cartilaginous tissue. An uncommon bone neoplasm, located almost exclusively in the spheno-occipital region, it is usually not considered in the differential diagnosis of a tumor with acute hemorrhage in the sellar region. We discuss the clinical and radiological characteristics which may allow one to differentiate chondroid chordoma from other tumors of this area. (orig.) With 3 figs., 9 refs.

Empty sella syndrome in a male child with failure to thrive.

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Rath, Debasmita; Sahoo, Ranjan Kumar; Choudhury, Jasashree; Dash, Dillip Kumar; Mohapatra, Anuspandana

2015-01-01

Empty sella syndrome (ESS) is commonly seen in adult and is considered as an infrequent finding in childhood. It may be diagnosed incidentally on imaging in asymptomatic children. However, most of the children with ESS present with features of hypothalamic-pituitary dysfunction. We report a case of ESS in a child with features of failure to thrive as well as hypopituitarism and review the literature briefly on the subject.

Panhypopituitarism with empty sella a sequel of pituitary hyperplasia due to chronic primary hypothyroidism.

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Dutta, Deep; Maisnam, Indira; Ghosh, Sujoy; Mukhopadhyay, Pradip; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2012-12-01

Asymptomatic reversible pituitary hyperplasia is common in patients with untreated primary hypothyroidism. Occurrence of empty sella (ES) in this scenario is extremely rare (only three reports till the date) and panhypopituitarism has not been reported in such patients. We report a 27 year man with severe short stature (height-133 cm; standard deviation score-7.36) and delayed puberty who had symptoms suggestive of hypothyroidism along with chronic persistent headache since 6 years of age. Pituitary imaging done for headache at 11 years age showed pituitary hyperplasia. He was diagnosed of primary hypothyroidism for the 1(st) time at 21 year age, a diagnosis which was likely missed for 15 years. Levothyroxine therapy leads to resolution of all symptoms and a height gain of 28 cm over last 6 years. Evaluation for lack of progression of puberty along with chronic nausea, vomiting, fatigue and weight loss for the last 1 year revealed secondary hypocortisolism (9 am cortisol-4.8 mcg/dl; ACTH-3.2 pg/ml), growth hormone deficiency (IGF-1: 65 ng/ml; normal: 117-325 ng/ml) and hypogonadotrophic hypogonadism (9 am testosterone: 98 ng/dl; [280-1500] LH-0.01 mIU/L [1.14-5.75]) with ES on magnetic resonance imaging (MRI) brain. Uncontrolled thyrotroph hyperplasia due to chronic untreated primary hypothyroidism for 15 years may have been damaging the adjacent corticotrophs, somatotrophs and gonadotrophs resulting in panhypopituitarism and empty sella. This is perhaps the first report of panhypopituitarism with empty sella syndrome developing in a patient with pituitary hyperplasia, a sequel of chronic untreated primary hypothyroidism.

78 FR 13870 - Roberto Sella; Notice of Declaration of Intention and Soliciting Comments, Protests, and/or...

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2013-03-01

... be used by a geothermal heating and cooling system located under the pond. Excess power will then be... 7, 2012. d. Applicant: Roberto Sella. e. Name of Project: Hydro-electric and Geothermal Alternative...

Schizophernia and empty sella – casual or correlated?

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Wix-Ramos, Richard Joseph; Capote, Eduardo; Mendoza, Milet; Garcia, Margreth; Ezequiel, Uribe

2011-01-01

Summary A male patient, 44 years old, with schizophrenia which started at the age of 18. At his last follow-up visit, laboratory tests and brain magnetic resonance imaging (MRI) were performed, revealing the presence of a sellar arachnoidocele. To our knowledge, there is only one similar case report of a set of male monozygotic triplets with schizophrenia and empty sella syndrome. High-resolution chromosome analysis found an extra band at chromosome 15p in all the triplets and their father. We performed a similar evaluation in our patient and his family to compare the results and identify new information on neuroanatomical abnormalities, hormonal alterations or genetic origins of schizophrenia. PMID:22802833

Panhypopituitarism with empty sella a sequel of pituitary hyperplasia due to chronic primary hypothyroidism

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Deep Dutta

2012-01-01

Full Text Available Asymptomatic reversible pituitary hyperplasia is common in patients with untreated primary hypothyroidism. Occurrence of empty sella (ES in this scenario is extremely rare (only three reports till the date and panhypopituitarism has not been reported in such patients. We report a 27 year man with severe short stature (height-133 cm; standard deviation score-7.36 and delayed puberty who had symptoms suggestive of hypothyroidism along with chronic persistent headache since 6 years of age. Pituitary imaging done for headache at 11 years age showed pituitary hyperplasia. He was diagnosed of primary hypothyroidism for the 1 st time at 21 year age, a diagnosis which was likely missed for 15 years. Levothyroxine therapy leads to resolution of all symptoms and a height gain of 28 cm over last 6 years. Evaluation for lack of progression of puberty along with chronic nausea, vomiting, fatigue and weight loss for the last 1 year revealed secondary hypocortisolism (9 am cortisol-4.8 mcg/dl; ACTH-3.2 pg/ml, growth hormone deficiency (IGF-1: 65 ng/ml; normal: 117-325 ng/ml and hypogonadotrophic hypogonadism (9 am testosterone: 98 ng/dl; [280-1500] LH-0.01 mIU/L [1.14-5.75] with ES on magnetic resonance imaging (MRI brain. Uncontrolled thyrotroph hyperplasia due to chronic untreated primary hypothyroidism for 15 years may have been damaging the adjacent corticotrophs, somatotrophs and gonadotrophs resulting in panhypopituitarism and empty sella. This is perhaps the first report of panhypopituitarism with empty sella syndrome developing in a patient with pituitary hyperplasia, a sequel of chronic untreated primary hypothyroidism.

Intrasellar abscess simultaning a Rathke's clef cyst

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Nakashima, Toshihiko; Murakawa, Takatsugu; Iwai, Tomohiko; Hirata, Toshifumi; Sakai, Noboru

1983-08-01

Both symptomatic Rathke's cleft cyst and intrasellar abscess are exceedingly rare. We present a case of intrasellar abscess developed in a Rathke's cleft cyst. A 60-year-old man was admitted to our hospital with complaints of polyuria, polydipsia, headache, and remittent fever. On admission, his neurological and ophthalmological examination was normal. Panhypopituitarism was revealed by endocrine testing. Plain-skull X-ray films showed no abnormalities, but a CT scan showed a small cystic lesion with a ring-like enhancement in the sella turcica and paranasal sinusitis. Further sagittal reconstruction of the CT scan demonstrated that the diaphragma sellae protruded upwards and that the pituitary stalk was markedly enhanced and enlarged. After the sinusitis improved, transsphenoidal surgery was carried out. Approximately 1 ml of the purulent contents were aspirated from the intrasellar region. The postoperative course was uneventful. A histological examination of the abscess wall revealed a ciliated columnar epithelium and inflammatory-cell infiltration beneath the epithelium.

Intrasellar abscess simultaning a Rathke's cleft cyst

International Nuclear Information System (INIS)

Nakashima, Toshihiko; Murakawa, Takatsugu; Iwai, Tomohiko; Hirata, Toshifumi; Sakai, Noboru

1983-01-01

Both symptomatic Rathke's cleft cyst and intrasellar abscess are exceedingly rare. We present a case of intrasellar abscess developed in a Rathke's cleft cyst. A 60-year-old man was admitted to our hospital with complaints of polyuria, polydipsia, headache, and remittent fever. On admission, his neurological and ophthalmological examination was normal. Panhypopituitarism was revealed by endocrine testing. Plain-skull X-ray films showed no abnormalities, but a CT scan showed a small cystic lesion with a ring-like enhancement in the sella turcica and paranasal sinusitis. Further sagittal reconstruction of the CT scan demonstrated that the diaphragma sellae protruded upwards and that the pituitary stalk was markedly enhanced and enlarged. After the sinusitis improved, transsphenoidal surgery was carried out. Approximately 1 ml of the purulent contents were aspirated from the intrasellar region. The postoperative course was uneventful. A histological examination of the abscess wall revealed a ciliated columnar epithelium and inflammatory-cell infiltration beneath the epithelium. (author)

Transsphenoidal hypophysectomy in beagle dogs: evaluation of a microsurgical technique

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Meij, B. P. [Utrecht University, Utrecht (Netherlands); Voorhout, G.; Ingh, T.S.G.A.M. van den; Hazewinkel, H. A.W.; Verlaat, J.W. van ' t

1997-07-15

Objective-Assessment of a microsurgical technique for transsphenoidalhypophysectomy in dogs. Study Design-Prospective study using physicalexamination, pituitary function testing, computed tomography (CT), and histological examination at autopsy. Animals or Sample Population-Eight laboratory beagle dogs. Methods-Pituitary function was assessed before and at 10 weeks after hypophysectomy by combined administration of four releasing hormones (anterior pituitary), administration of haloperidol (pars intermedia), and infusion of hypertonic saline (posterior pituitary). Results-CT imaging enabled accurate preoperative localization of the pituitary. Appropriate positioning and surgical technique facilitated exposure of the pituitary and its extraction without hemorrhage. Postoperative recovery was generally uncomplicated. None of the eight dogs had somatotropic. gonadotropic, lactotropic, melanotropic, or posterior pituitary responses to stimulation at 10 weeks after hypophysectomy. Four dogs (ACTH nonresponders) also had no corticotropicresponse and four (ACTH responders) bad small but significant responses in the combined anterior pituitary function test. Adrenocortical atrophy was more pronounced in the ACTH nonresponders than in the responders. No residual pituitary tissue was found along the ventral hypothalamic diencephalon but nests of pituitary cells were found embedded infibrous tissue in the sella turcica. Conclusions-The surgical technique proved to be safe and effective. Microscopic nests of pituitary cells in the sella turcica may be responsible for residual corticotropic response to hypophysiotropic stimulation after hypophysectomy. Clinical Relevance-The surgical technique may be used in the treatment of dogs with pituitary-dependent hyperadrenocorticism. The corticotropic response is the most sensitive criterion in assessing completeness of hypophysectomy in dogs. (C) Copyright 1997 by The American College of Veterinary Surgeons.

Transsphenoidal hypophysectomy in beagle dogs: evaluation of a microsurgical technique

International Nuclear Information System (INIS)

Meij, B.P.; Voorhout, G.; Ingh, T.S.G.A.M. van den; Hazewinkel, H.A.W.; Verlaat, J.W. van 't

1997-01-01

Objective-Assessment of a microsurgical technique for transsphenoidalhypophysectomy in dogs. Study Design-Prospective study using physicalexamination, pituitary function testing, computed tomography (CT), and histological examination at autopsy. Animals or Sample Population-Eight laboratory beagle dogs. Methods-Pituitary function was assessed before and at 10 weeks after hypophysectomy by combined administration of four releasing hormones (anterior pituitary), administration of haloperidol (pars intermedia), and infusion of hypertonic saline (posterior pituitary). Results-CT imaging enabled accurate preoperative localization of the pituitary. Appropriate positioning and surgical technique facilitated exposure of the pituitary and its extraction without hemorrhage. Postoperative recovery was generally uncomplicated. None of the eight dogs had somatotropic. gonadotropic, lactotropic, melanotropic, or posterior pituitary responses to stimulation at 10 weeks after hypophysectomy. Four dogs (ACTH nonresponders) also had no corticotropicresponse and four (ACTH responders) bad small but significant responses in the combined anterior pituitary function test. Adrenocortical atrophy was more pronounced in the ACTH nonresponders than in the responders. No residual pituitary tissue was found along the ventral hypothalamic diencephalon but nests of pituitary cells were found embedded infibrous tissue in the sella turcica. Conclusions-The surgical technique proved to be safe and effective. Microscopic nests of pituitary cells in the sella turcica may be responsible for residual corticotropic response to hypophysiotropic stimulation after hypophysectomy. Clinical Relevance-The surgical technique may be used in the treatment of dogs with pituitary-dependent hyperadrenocorticism. The corticotropic response is the most sensitive criterion in assessing completeness of hypophysectomy in dogs. (C) Copyright 1997 by The American College of Veterinary Surgeons

Pseudotumor Cerebri Resulting in Empty Sella Syndrome and Multiple Pituitary Hormone Deficiencies

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2017-09-14

A 17 year old male was referred to pediatric endocrinology with concerns for stalled puberty in the setting of known PTC. He was diagnosed with PTC...size led to a preliminary laboratory evaluation. This resulted In a referral to pediatric endocrinology for significantly low testosterone and an...studies were reviewed and a partially empty sella was appreciated by a pediatric radiologist on retrospective evaluation (Image 1 ). There were no

Use of radioimmunoassay to diagnose some forms of endocrine sterility

International Nuclear Information System (INIS)

Balabolkin, M.I.; Gerasimov, G.A.

1984-01-01

The possibility is considered of using a metoclopramide test combined with radioimmunoassay for determing prolactin in the blood to diagnose some forms of endocrine sterility Of 17 women examined 5 are practically healthy, sterility of 6 women is caused by tumor of hypophysis verified by X-rayograms, 6 women suffered from disorderded prolactin secretion and sterility without roentgenologic signs of disordered sella turcica. Metoclopramide has been injected intravenously in the 10 mm dose. A series of advantages is noted of the metoclopramide sample characteristic of high availability of the preparation and practically complete absence of side-effects

Investigating the application of diving endoscopic technique in determining the extent of pituitary adenoma resection via the trans-nasal-sphenoidal approach.

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Gao, Hai-Bin; Wang, Li-Qing; Zhou, Jian-Yun; Sun, Wei

2018-04-01

The aim of the present study was to investigate the advantages and disadvantages of the diving endoscopic technique in pituitary adenoma surgery, and the application value in determining the extent of tumor resection. A total of 37 patients with pituitary adenoma initially underwent tumor resection under an endoscope-assisted microscope via standard trans-nasal-sphenoidal approach, and tumor cavity structure was observed by applying the diving endoscopic technique. Surgery was subsequently performed again under a microscope or endoscope. The diving endoscopic technique allowed surgeons to directly observe the structure inside a tumor cavity in high-definition. In the present study, 24 patients had pituitary macroadenomas or microadenomas that did not invade the cavernous sinus, and were considered to have undergone successful total resection. Among these patients, no tumor residues were observed through the diving endoscopic technique. Some white lichenoid or fibrous cord-like tissues in the tumor cavity were considered to be remnants of tumors. However, pathology confirmed that these were not tumor tissues. For tumors that invaded the cavernous sinus in 13 patients, observation could only be conducted under the angulation endoscope of the diving endoscope; i.e., the operation could not be conducted under an endoscope. The present study suggests that the diving endoscopic technique may be used to directly observe the resection extent of tumors within the tumor cavity, especially the structure of the tumor cavity inside the sella turcica. The present study also directly validates the reliability of pituitary adenoma resection under endoscope-assisted microscope. In addition, the diving endoscopic technique also allows the surgeon to observe the underwater environment within the sella turcica.

Pituitary gland tumors

International Nuclear Information System (INIS)

Jesser, J.; Schlamp, K.; Bendszus, M.

2014-01-01

This article gives an overview of the most common tumors of the pituitary gland and the differential diagnostics with special emphasis on radiological diagnostic criteria. A selective search of the literature in PubMed was carried out. Pituitary adenomas constitute 10-15 % of all intracranial tumors and are the most common tumors of the sellar region. Tumors smaller than 1 cm in diameter are called microadenomas while those larger than 1 cm in diameter are called macroadenomas. Approximately 65 % of pituitary gland adenomas secrete hormones whereby approximately 50 % secrete prolactin, 10 % secrete growth hormone (somatotropin) and 6 % secrete corticotropin. Other tumors located in the sella turcica can also cause endocrinological symptoms, such as an oversecretion of pituitary hormone or pituitary insufficiency by impinging on the pituitary gland or its stalk. When tumors spread into the space cranial to the sella turcica, they can impinge on the optic chiasm and cause visual disorders. A common differential diagnosis of a sellar tumor is a craniopharyngeoma. In children up to 10 % of all intracranial tumors are craniopharyngeomas. Other differential diagnoses for sellar tumors are metastases, meningiomas, epidermoids and in rare cases astrocytomas, germinomas or Rathke cleft cysts As these tumors are located in an anatomically complex region of the skull base and are often very small, a highly focused imaging protocol is required. The currently favored modality is magnetic resonance imaging (MRI) with the administration of a contrast agent. The sellar region should be mapped in thin slices. In cases of suspected microadenoma the imaging protocol should also contain a sequence with dynamic contrast administration in order to assess the specific enhancement characteristics of the tumor and the pituitary gland. (orig.) [de

[Pituitary gland tumors].

Science.gov (United States)

Jesser, J; Schlamp, K; Bendszus, M

2014-10-01

This article gives an overview of the most common tumors of the pituitary gland and the differential diagnostics with special emphasis on radiological diagnostic criteria. A selective search of the literature in PubMed was carried out. Pituitary adenomas constitute 10-15% of all intracranial tumors and are the most common tumors of the sellar region. Tumors smaller than 1 cm in diameter are called microadenomas while those larger than 1 cm in diameter are called macroadenomas. Approximately 65% of pituitary gland adenomas secrete hormones whereby approximately 50% secrete prolactin, 10% secrete growth hormone (somatotropin) and 6% secrete corticotropin. Other tumors located in the sella turcica can also cause endocrinological symptoms, such as an oversecretion of pituitary hormone or pituitary insufficiency by impinging on the pituitary gland or its stalk. When tumors spread into the space cranial to the sella turcica, they can impinge on the optic chiasm and cause visual disorders. A common differential diagnosis of a sellar tumor is a craniopharyngeoma. In children up to 10% of all intracranial tumors are craniopharyngeomas. Other differential diagnoses for sellar tumors are metastases, meningiomas, epidermoids and in rare cases astrocytomas, germinomas or Rathke cleft cysts As these tumors are located in an anatomically complex region of the skull base and are often very small, a highly focused imaging protocol is required. The currently favored modality is magnetic resonance imaging (MRI) with the administration of a contrast agent. The sellar region should be mapped in thin slices. In cases of suspected microadenoma the imaging protocol should also contain a sequence with dynamic contrast administration in order to assess the specific enhancement characteristics of the tumor and the pituitary gland.

Ectopic pituitary null cell adenoma arising from the infundibulum in the third ventricle: A successful endonasal transsphenoidal resection after long-term follow-up MR imaging – A technical note

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Yuichiro Yoneoka, M.D., Ph.D.

2017-12-01

Conclusion: To our best knowledge, this is the first case with long-term preoperative follow-up images, which can bridge the knowledge gap in operations of third ventricle ectPA as following: (1 Truly third ventricle ectPA can exist, (2 the third ventricle ectPA extended into the sella turcica along the pituitary stalk, (3 this ectPA can arise from the suprasellar peri-infundibular ectopic pituitary cells or the pars tuberalis of the adenohypophysis, and therefore adhere to the optic chiasm, (4 thus neurosurgeons should take great care in resection of ectPA arising from the infundibulum, and (5 it can be resected through an endoscopic extended transsphenoidal approach.

Cerebrospinal fluid rhinorrhea as a complication of ACTH-secreting pituitary macroadenoma in a patient with morbid obesity

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Dar'ya Viktorovna Petrova

2014-11-01

Full Text Available Cushing's disease (CD is a progressive neuroendocrine disease caused by a pituitary tumor producing excessive amounts of ACTH. In most cases (80-85% the cause of the disease is a pituitary corticotroph microadenomas (located within the sella, measuring 3–10 mm, rarely multiple microadenomas and only 15% of cases are presented as corticotroph hyperplasia or pituitary macroadenoma extending beyond the sella. The macroadenomas in CD usually extend suprasellar (10%, infrasellar tumor growth is relatively rare (5%. If the clinical picture is subtle, the symptoms are caused by the development "mass effect" of the tumor as it propagates to the surrounding pituitary structures. Suprasellar growth leads to compression of the optic chiasm with narrowing of visual fields, infrasellar growth destructs the bottom of the sella turcica and may cause nasal cerebrospinal fluid leak, which is dangerous due depressurization of the cranial cavity and its communication with environmental pathogens, development of life-threatening conditions such as meningitis, meningoencephalitis, ventriculitis. Leading life-threatening complications of the CD are infectious and cardiovascular. But in the case of nasal liquorrhea with expansion of the tumor in sphenoid sinus with destruction of the bottom of the sella, there is an immediate threat to the life of the patient. This article presents an example of a patient with morbid obesity and lack of specific clinical manifestations of CD, in whom the diagnosis of disease CD was made on the results of laboratory and instrumental examination, which experienced a spontaneous nasal cerebrospinal fluid leak.

The "suprasellar notch," or the tuberculum sellae as seen from below: definition, features, and clinical implications from an endoscopic endonasal perspective.

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de Notaris, Matteo; Solari, Domenico; Cavallo, Luigi M; D'Enza, Alfonso Iodice; Enseñat, Joaquim; Berenguer, Joan; Ferrer, Enrique; Prats-Galino, Alberto; Cappabianca, Paolo

2012-03-01

The tuberculum sellae is a bony elevation ridge that lines up the anterior aspect of the sella, dividing it from the chiasmatic groove. The recent use of the endoscopic endonasal transtuberculum approach has provided surgeons with a method to reach the suprasellar area, offering a new surgical point of view somehow "opposite" of this area. The authors of this study aimed to define the tuberculum sellae as seen from the endoscopic endonasal view while also providing CT-based systematic measurements to objectively detail the anatomical features of such a structure, which was renamed the "suprasellar notch." The authors analyzed routine skull CT scans from 24 patients with no brain pathology or fractures and measured the interoptic distance at the level of the limbus sphenoidale, the chiasmatic groove sulcal length and width, and the angle of the suprasellar notch. Indeed, the suprasellar notch was defined as the angle between 2 lines, the first passing through the tuberculum sellae midpoint and perpendicular to the cribriform plate, and a second line passing between 2 points, the midpoints of the limbus sphenoidale and the tuberculum sellae. Moreover, the authors performed on 15 cadaveric heads an endoscopic endonasal transplanum transtuberculum approach with the aid of a neuronavigator to achieve a step-by-step comparison with the radiological data. The whole CT scanning set was statistically analyzed to determine the statistical interdependency of the suprasellar notch angle with the other 3 measurements, that is, the sulcal length at the midline, the interoptic distance at the optic canal entrance, and the interoptic distance at the limbus. Based on the endoscopic endonasal view and CT imaging analysis, the authors identified a certain anatomical variability and thus introduced a new classification of the suprasellar notch: Type I, angle 138°. They then analyzed the surgical implications of the endoscopic endonasal approach to the suprasellar area, which could be

Computed tomography of Rathke's cleft cyst

International Nuclear Information System (INIS)

Shiokawa, Yoshiaki; Teramoto, Akira; Mayanagi, Yoshiaki; Hanamura, Tetsu; Noguchi, Makoto; Takakura, Kintomo.

1986-01-01

The computed tomography (CT) findings in six cases of Rathke's cleft cyst (RCC) were presented. According to the location of the RCC, we divided these cases into two types - the suprasellar type and the intrasellar type. The characteristic CT findings are as follows: SUPRASELLAR type 1. smooth, round mass, 2. various densities, 3. no enhancement, INTRASELLAR type 1. low-density area in the posterior sella turcica, 2. no enhancement, 3. suprasellar high-density mass; enhanced pituitary gland pushed up by the intrasellar RCC. As RCC are more common than was formerly suspected, this disease should always be considered in the differential diagnosis of a patient showing a non-enhancing, non-calcified sellar/suprasellar cyst on CT scans. (author)

Computed tomography of Rathke's cleft cyst

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Shiokawa, Yoshiaki; Teramoto, Akira; Mayanagi, Yoshiaki; Hanamura, Tetsu; Noguchi, Makoto; Takakura, Kintomo

1986-02-01

The computed tomography (CT) findings in six cases of Rathke's cleft cyst (RCC) were presented. According to the location of the RCC, we divided these cases into two types - the suprasellar type and the intrasellar type. The characteristic CT findings are as follows: SUPRASELLAR type 1. smooth, round mass, 2. various densities, 3. no enhancement, INTRASELLAR type 1. low-density area in the posterior sella turcica, 2. no enhancement, 3. suprasellar high-density mass; enhanced pituitary gland pushed up by the intrasellar RCC. As RCC are more common than was formerly suspected, this disease should always be considered in the differential diagnosis of a patient showing a non-enhancing, non-calcified sellar/suprasellar cyst on CT scans.

Polyglandular autoimmune syndrome iii with hypoglycemia and association with empty sella and hypopituitarism

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Samia Abdulla Bokhari

2017-01-01

Full Text Available A 25-year-old Saudi female with a known case of autoimmune thyroiditis presented to the Emergency Room in stuporous condition. A blood test revealed a blood sugar level of 1.7 mmols/l (30.6 mg/dl. The patient was resuscitated with intravenous glucose. Further evaluations of the patient revealed celiac disease and idiopathic thrombocytopenia with preexisting autoimmune thyroiditis (polyglandular autoimmune syndrome III [PAS III]. The severe hypoglycemia, coupled with 6 years of infertility evaluation, revealed a rare association of empty sella syndrome with hypopituitarism {PAS II}.

Anatomical features of skull base and oral cavity: a pilot study to determine the accessibility of the sella by transoral robotic-assisted surgery.

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Amelot, Aymeric; Trunet, Stephanie; Degos, Vincent; André, Olivier; Dionnet, Aurore; Cornu, Philippe; Hans, Stéphane; Chauvet, Dorian

2015-10-01

The role of transoral robotic surgery (TORS) in the skull base emerges and represents the natural progression toward miniinvasive resections in confined spaces. The accessibility of the sella via TORS has been recently described on fresh human cadavers. An anatomic study is mandatory to know if this approach would be feasible in the majority of patients regardless of their oral morphological features. From 30 skull base CT scans from patients who were asked to open their mouth as wide as they can, we measured specific dimensions of the oral cavity and the skull base, such as length of the palate, mouth opening and distance from the sella to the palate. All data were acquired on a sagittal midline plane and on a 25° rotation plane, which simulated the axis of the robotic instruments. Looking at the projection of the dental palatine line on the sella, we studied possible predictive factors of sellar accessibility and tried to bring objective data for surgical feasibility. We also proposed an angle α to study the working angle at the skull base. We observed that the maximal mouth opening was a good predictive factor of sellar accessibility by TORS (p < 0.05). The mouth aperture threshold value for a good sensitivity, over 80 %, was comparable to the mean value of mouth opening in our series, 38.9 and 39.4 mm respectively. Moreover, we showed a statistically significant increase of the working angle α at the skull base comparing the lateral access to the midline one (p < 0.05). This seemed to quantitatively demonstrate that the robotic arms placed at the labial commissure of the mouth can reach the sella. From these anatomical features and previous cadaveric dissections, we assume that TORS may be feasible on a majority of patients to remove pituitary adenomas.

Microadenomas e adenomas hipersecretantes da hipófise, aspectos anátomo-radiológicos Microadenomas and hypersecreting pituitary adenomas: radiographic aspects

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Jean Lorrain Vezina

1975-06-01

Full Text Available São apresentados os primeiros sinais radiográficos de alteração selar encontrados nos casos de adenomas hipofisários hipersecretantes. O achado de duplo contôrno selar e de pequenas bosseladuras com o auxílio da tomografia selar tem permitido o diagnóstico da localização de microadenomas, a partir do que tem sido possível operar os pacientes no estágio inicial, quando o tumor não causou ainda lesões irreversíveis nos tecidos circunjacentes, o que facilita sobremaneira a cirurgia sem lesar o tecido hipofisário sadio, dando maiores possibilidades para o restabelecimento das funções hipofisárias ao normal. É feita uma classificação anátomo-radiológica da sela túrcica em 4 estágios, que é de grande utilidade para o prognóstico cirúrgico pois observa-se a cura em mais de 90% dos casos no estágio 1, de 75% no estágio 2, de 50% no estágio 3 e de menos de 10% no estágio 4, na primeira cirurgia.The early radiographic changes of the sella turcica in the cases of hypersecreting pituitary adenomas (Cushing disease, acromegaly, amenorrhea-galac- torrhea are reported and discussed. The finding of the double contour of the sellar floor and the small crescentic bulging of its antero-inferior wall, with the aid of the tomographic cuts of the sella, has permited the diagnosis of the microadenoma's localization. With this it is possible the achievement of a seletive excision of the lesion in the initial stage, when the tumor has not caused yet irreversible damage to the inside normal pituitary tissue. This surgery is perfomed in the precocious stage with the primary goal to preserve the normal gland, without hurt it to avoid postoperative hipopituitarism. A anatomo-radiologic classification of the alterations sella turcica in 4 grades is made, which is of great utility for the surgical prognostic, since we have observed clinical and biological cure over 90% in the grade 1, 75% in the grade 2, 50% in the grade 3 and up to 10% in the

A study of radiation exposure dose in young dental patients

International Nuclear Information System (INIS)

Hatakeyama, Atsushi

1983-01-01

In order to clarify the trend in dental radiography for young patients up to 18 years old and the accompanying radiation exposures, surveys were made at Fukuoka Dental College Hospital and thirty-five dental offices in Fukuoka city and Kitakyushu city. Each kind of radiography increased in average number with age and 16-18 group was given 4.60 times of radiography of one kind or another in the clinic of college hospital. In the dental offices, the number of radiography taken was about one-fourth that of the clinic of college hospital. Although exposure dose varies with exposure factors, distance and angle of exposure, in addition to time factor, were found to affect doses subtly. In the clinic of college hospital the average of estimated doses to organs per person per year were 105.4 mrad (25.2 mrad for 5-year-old children) in the salivary gland, 55.9 mrad (18.9 mrad for 5-year-old) in the thyroid gland, 52.1 mrad (15.0 mrad for 5-year-old) in the lens of the eye and 52.2 mrad (8.7 mrad for 5-year-old) in the sella turcica. In the dental offices, the same average of estimated doses to organs were 40.5 mrad (7.4 mrad for 5-year-old) in the salivary gland, 17.4 mrad (8.0 mrad for 5-year-old) in the thyroid gland, 12.2 mrad (6.1 mrad for 5-year-old) in the lens of eye and 13.1 mrad (1.3 mrad for 5-year-old) in the sella turcica. In all kinds of radiograpy, the estimated doses in genital glands were in μrad. In the dental offices, both the percentage of young patients to all patients and the radiographing rate were lower as compared with those in the clinic of college hospital. The estimated doses were also lower at one-half to one-fifth and those by age and by organ were found to be one-tenth or lower. (J.P.N.)

Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome

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Jovanović Dragan

2009-01-01

Full Text Available Introduction. Hemorrhagic fever with renal syndrome (HFRS is acute infective multisystemic disease followed by febrility, hemorrhages and acute renal insufficiency. Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of HFRS, while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. Case report. We presented a patient with the development of chronic renal insufficiency and hypopituitarism as complication that had been diagnosed six years after Hantavirus infection. Magnetic resonance of the pituitary gland revealed atrophy and empty sella turcica. Conclusion. Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS.

Pituitary gland tumors; Hypophysentumoren

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Jesser, J.; Schlamp, K.; Bendszus, M. [Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Neuroradiologie, Heidelberg (Germany)

2014-10-15

This article gives an overview of the most common tumors of the pituitary gland and the differential diagnostics with special emphasis on radiological diagnostic criteria. A selective search of the literature in PubMed was carried out. Pituitary adenomas constitute 10-15 % of all intracranial tumors and are the most common tumors of the sellar region. Tumors smaller than 1 cm in diameter are called microadenomas while those larger than 1 cm in diameter are called macroadenomas. Approximately 65 % of pituitary gland adenomas secrete hormones whereby approximately 50 % secrete prolactin, 10 % secrete growth hormone (somatotropin) and 6 % secrete corticotropin. Other tumors located in the sella turcica can also cause endocrinological symptoms, such as an oversecretion of pituitary hormone or pituitary insufficiency by impinging on the pituitary gland or its stalk. When tumors spread into the space cranial to the sella turcica, they can impinge on the optic chiasm and cause visual disorders. A common differential diagnosis of a sellar tumor is a craniopharyngeoma. In children up to 10 % of all intracranial tumors are craniopharyngeomas. Other differential diagnoses for sellar tumors are metastases, meningiomas, epidermoids and in rare cases astrocytomas, germinomas or Rathke cleft cysts As these tumors are located in an anatomically complex region of the skull base and are often very small, a highly focused imaging protocol is required. The currently favored modality is magnetic resonance imaging (MRI) with the administration of a contrast agent. The sellar region should be mapped in thin slices. In cases of suspected microadenoma the imaging protocol should also contain a sequence with dynamic contrast administration in order to assess the specific enhancement characteristics of the tumor and the pituitary gland. (orig.) [German] Diese Arbeit ist eine Uebersicht ueber die haeufigsten Hypophysentumoren und deren Differenzialdiagnosen mit Augenmerk auf die

A primary sellar neuroblastoma mimicking a pituitary adenoma: A case report

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Kim, Dong Gun; Heo, Young Jin; Kim, Eun Kyoung; Baek, Jin Wook; Jeong, Hae Woong; Jung, Hyun Seok [Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

2016-12-15

Intracranial neuroblastomas are uncommon malignant tumors that usually arise in the supratentorial parenchymal or paraventricular location. A primary neuroblastoma arising in the sella turcica is extremely rare. We report a case of a 76-year-old man who presented with progressive bitemporal hemianopsia. His pituitary hormone levels were within the normal range, except for slightly increased prolactin. Pituitary magnetic resonance imaging revealed a solitary sellar mass with supra- and parasellar extension that mimicked a non-functioning pituitary adenoma or meningioma. The tumor was excised by transsphenoidal resection. Histopathologic analysis revealed small cells surrounded by a dense fibrillary stroma as well as strong expression of neural markers. Hence, the patient was diagnosed with sellar neuroblastoma. Prolactin levels normalized in the immediate postoperative period, although visual disturbances persisted. Herein, we describe the clinical manifestations, MRI characteristics, and histopathologic findings of this case.

Large pituitary incidentaloma in a patient with sarcoidosis

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Leena Jalota

2014-07-01

Full Text Available A 60 year old male with a medical history of pulmonary sarcoidosis and chronic low testosterone presented to his allergist for excessive lacrimation. Computed tomography (CT scan of sinuses ordered for possible blocked nasolacrimal duct revealed an abnormal expansion of the sella turcica. Magnetic resonance imaging suggested a homogeneously enhancing 4 cm soft tissue mass enveloping the internal carotid and abutting the optic nerves. Since the patient indicated no symptoms, it was felt to be consistent with a pituitary incidentaloma. Laboratory investigation showed only minimally elevated prolactin. Visual field testing at the office was normal but computed campimetry was suggestive of few minimally depressed points in the supra-temporal quadrant on the right. Even with high suspicion of neurosarcoidosis, the patient had a surgical indication so he underwent transsphenoidal excision of the mass with no complications. Pathology was consistent with a null-cell pituitary adenoma.

Computed tomography in neoplastic diseases of the skull base and adjacent areas using EMI scanner CT-1000

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Ono, Yoshimi; Ohtake, Eiji; Asakura, Koichi; Tanohata, Kazunori; Ito, Otomasa

1980-01-01

CT-findings of 145 patients with and without neoplastic diseases of the skull base were evaluated using EMI CT-1000. Analysis of 64 patients without any lesion at the skull base showed more artifacts compared with that of higher slices, so that good or fair images were obtained only in 64% of this groups of patients. The most important factor in producing artifacts are considered to be caused by patient's movement. We also evaluated the tumor extension to the skull base in 81 patients. They were 24 brain tumors, 21 pituitary adenomas, and 36 nasopharyngeal and paranasal cancers. Four out of 24 brain tumors showed extracranial extension, 12 pituitary adenomas infiltrating outside of the sella turcica, and 10 cases of nasopharyngeal cancers showed intracranial extension. It was concluded that CT presented an excellent information in evaluating the degree of extension of neoplasms which invading to the skull base. (author)

Panhypopituitarism due to metastases to the hypothalamus and the pituitary resulting from primary breast cancer: a case report and review of the literature.

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Peppa, Melpomeni; Papaxoinis, Georgios; Xiros, Nikolaos; Raptis, Sotirios A; Economopoulos, Theofanis; Hadjidakis, Dimitrios

2009-11-01

Pituitary metastasis occurs rarely in cancer patients and often remains undiagnosed. However, early detection and appropriate treatment can improve the patient's quality of life and possibly prolong survival. Herein, we describe the case of a 52-year-old woman with panhypopituitarism caused by metastases to the hypothalamus and pituitary from primary breast cancer. She had a 5-year history of breast cancer with metastases to the bones 1.5 years after initial diagnosis and mastectomy. She presented with severe headaches, generalized fatigue, dizziness, hypotension, difficulties with balance and coordination, polyuria, and polydipsia. Laboratory work-up revealed panhypopituitarism (central diabetes insipidus; hypothyroidism; and low prolactin, gonadotrophin, and adrenocorticotropic hormone levels), and magnetic resonance imaging confirmed the pituitary and hypothalamic involvement. She received hormone replacement therapy, radiation therapy of the sella turcica and suprasellar lesion, and chemotherapy, with significant improvement of her clinical status, but she died 15 months later.

Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves.

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Kim, Soo Ryang; Kanda, Fumio; Kobessho, Hiroshi; Sugimoto, Koji; Matsuoka, Toshiyuki; Kudo, Masatoshi; Hayashi, Yoshitake

2006-11-07

We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-year-old woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI) disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves

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Soo Ryang Kim; Fumio Kanda; Hiroshi Kobessho; Koji Sugimoto; Toshiyuki Matsuoka; Masatoshi Kudo; Yoshitake Hayashi

2006-01-01

We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-yearold woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI)disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement.The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

Pituitary Adenoma Recurrence Suspected on Central Hyperthyroidism Despite Empty Sella and Confirmed by 68Ga-DOTA-TOC PET/CT.

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Gauthé, Mathieu; Sarfati, Julie; Bourcigaux, Nathalie; Christin-Maitre, Sophie; Talbot, Jean-Noël; Montravers, Françoise

2017-06-01

Thyrotropin-secreting pituitary adenomas are very rare tumors, known to present overexpression of somatostatin receptor subtype 2 and which may consequently demonstrate abnormal uptake on Ga-DOTA-TOC PET/CT. A 67-year-old woman with a history of operated pituitary macroadenoma presented with symptoms of hyperthyroidism including a large goiter. Her serum thyroid hormone levels were in favor of central hyperthyroidism. Pituitary MRI depicted an empty sella but visualized an ambiguous lesion centered on the left sphenoidal sinus. Complementary Ga-DOTA-TOC PET/CT finally demonstrated intense uptake by the sphenoidal lesion, confirming recurrence of the pituitary adenoma.

A Morphometric Study of the Foramen of Diaphragma Sellae and Delineation of Its Relation to Optic Neural Pathways through Computer Aided Superimposition

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Doris George Yohannan

2015-01-01

Full Text Available The diaphragma sellae (DS is a fold of dura that forms a partial roof over the pituitary gland. The foramen of the diaphragma sellae (FDS is thereby a pathway for suprasellar extension of pituitary tumors. The purpose of this study was to describe the anatomical dimensions of the DS and FDS and to understand the relationship of FDS with the overlying optic chiasma. The study was conducted in 100 autopsy cases. Measurements were taken using vernier calipers. Photographs, taken before and after removal of optic pathway, were superimposed using image processing software. The results showed that the mean A-P dimension of DS was 1.17 ± 0.48 cm; the lateral dimension of DS was 1.58 ± 0.60 cm. The mean A-P dimension of FDS was 0.66 ± 0.42 cm; the lateral dimension of FDS was 0.82 cm ± 0.54 cm. The shapes of FDS were irregular (40%, transversely oval (29%, circular (13%, sagittally oval (11%, or trapezoid with posterior dimension more than the anterior one (6% or anterior dimension more than the posterior one (1%. The margins of FDS were either well defined (31% or ill defined (69%. The positional relation of FDS to optic chiasma was also found out.

Transsphenoidal pituitary resection with intraoperative MR guidance: preliminary results

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Pergolizzi, Richard S., Jr.; Schwartz, Richard B.; Hsu, Liangge; Wong, Terence Z.; Black, Peter M.; Martin, Claudia; Jolesz, Ferenc A.

1999-05-01

The use of intraoperative MR image guidance has the potential to improve the precision, extent and safety of transsphenoidal pituitary resections. At Brigham and Women's Hospital, an open-bore configuration 0.5T MR system (SIGNA SP, GE Medical Systems, Milwaukee, WI) has been used to provide image guidance for nine transsphenoidal pituitary adenoma resections. The intraoperative MR system allowed the radiologist to direct the surgeon toward the sella turcica successfully while avoiding the cavernous sinus, optic chiasm and other sensitive structures. Imaging performed during the surgery monitored the extent of resection and allowed for removal of tumor beyond the surgeon's view in five cases. Dynamic MR imaging was used to distinguish residual tumor from normal gland and postoperative changes permitting more precise tumor localization. A heme-sensitive long TE gradient echo sequence was used to evaluate for the presence of hemorrhagic debris. All patients tolerated the procedure well without significant complications.

Inflammatory Myofibroblastic Tumour of the Skull Base

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Jean-Philippe Maire

2013-01-01

Full Text Available Inflammatory myofibroblastic tumors (IMTs are rare benign clinical and pathological entities. IMTs have been described in the lungs, abdomen, retroperitoneum, and extremities but rarely in the head and neck region. A 38-year-old man presented with headache, right exophthalmia, and right 6th nerve palsy. A CT scan revealed enlargement of the right cavernous sinus and osteolytic lesions of the right sphenoid and clivus. MR imaging showed a large tumor of the skull base which was invading the sella turcica, right cavernous sinus, and sphenoidal sinus. A biopsy was performed and revealed an IMT. Corticosteroids were given for 3 months but were inefficient. In the framework of our pluridisciplinary consultation, fractionated conformal radiotherapy (FRT was indicated at a low dose; 20 Gy in 10 fractions of 2 Gy over 12 days were delivered. Clinical response was complete 3 months after FRT. Radiological response was subtotal 6 months after FRT. Two years later, the patient is well.

Magnetic resonance imaging of pituitary adenomas

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Bonneville, Jean-Francois; Bonneville, Fabrice; Cattin, Francoise [University Hospital, Department of Neuroradiology, Besancon (France)

2005-03-01

Today, MR is the only method needed for the morphological investigation of endocrine-active pituitary adenomas. In acromegaly and Cushing's syndrome, the therapeutic attitude is directly dictated by MR data. We present the MR aspect of pituitary adenomas according to size, sex, age, endocrine activity and a few particular conditions such as hemorrhagic pituitary adenomas, pituitary adenomas during pregnancy, cavernous sinus invasion and postsurgical changes. When an intrasellar mass extending out of the sella turcica is detected, the goal of the MR examination is to indicate precisely the origin of the tumor, its extension in relation to the various surrounding structures, its structure and its enhancement in order to help in the differential diagnosis. Demonstration of very small pituitary adenomas remains a challenge. When SE T1- and Turbo SE T2-weighted sequences are non-diagnostic, enhanced imaging becomes mandatory; half-dose gadolinium injection, delayed sequence, dynamic imaging can be of some help. (orig.)

Primary intravascular large B-cell lymphoma of pituitary

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K R Anila

2012-01-01

Full Text Available A 68-year-old retired nurse, who was a known hypertensive on medication, presented with prolonged fever of 2-month duration without any clinical evidence of infection. On examination she had altered mental status. She also had other nonspecific complaints such as sleep disturbances, loss of weight, etc. On investigation, she was found to have anemia, thrombocytopenia, raised erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, and lactate dehydrogenase (LDH values. She also had electrolyte imbalance. Radiological evaluation of brain showed mass lesion in the sella turcica, suggestive of pituitary adenoma. Biochemical evaluation showed hypopituitarism. Trans-sphenoidal biopsy was done. Based on histopathological and immunohistochemical findings a diagnosis of intravascular large B-cell lymphoma (IVLBCL of pituitary was made. Our patient′s condition deteriorated rapidly and she succumbed to her illness before therapy could be initiated. We are reporting this case because of the rare subtype of large B-cell lymphoma presenting at an extremely unusual primary site.

Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas.

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Sheehan, M T; Atkinson, J L; Kasperbauer, J L; Erickson, B J; Nippoldt, T B

1999-07-01

To assess the advantages and disadvantages of an endoscopic transnasal approach to pituitary surgery for a select group of clinically nonfunctioning macroadenomas and to compare results of this approach with the sublabial transseptal approach at a single institution. We retrospectively reviewed the records of 26 patients with clinically nonfunctioning pituitary macroadenomas approached endoscopically and 44 matched control patients with the same tumors approached sublabially between January 1, 1995, and October 31, 1997. At baseline, the groups were not significantly different for age, sex distribution, number of comorbid conditions, visual field defects, degree of anterior pituitary insufficiency, or preoperative assessment of tumor volume or invasiveness. Mean (SD) operative times were significantly reduced in the endoscopic group vs the sublabial group: 2.7 (0.7) hours vs 3.4 (0.9) hours (P working channel to the sella turcica. For these reasons, the endoscopic approach or its variation is an alternative to the sublabial approach but should be considered only by experienced pituitary neurosurgeons.

Imaging Evaluation of the Location and Fenestration of Sellar Floor during Endonasal Transsphenoidal Surgery in Patients with Pituitary Adenomas.

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Wang, Shousen; Qin, Yong; Xiao, Deyong; Wu, Zhifeng; Wei, Liangfeng

2018-05-03

To evaluate the clinical value of three-dimensional (3D) CT reconstruction of the sphenoidal sinus separation in localizing sellar floor during endonasal transsphenoidal surgery, and determine the size and location of sellar floor fenestration. After exclusion,51 patients were eligible for study inclusion. A pre-operative CT scan of the paranasal sinus and CT scan and MRI of the pituitary gland were obtained. Sphenoidal sinus separation was reconstructed using Mimics 15.0 software and the quantity, shape, and orientation were observed and compared with intra-operative data, the purpose of which was to guide the localization of sellar floor. Anatomic variation of the sphenoidal sinus and adjacent structures, tumor and sella turcica morphology, minimal distance between the cavernous segment of the internal carotid artery（CSICA） bilaterally, and the shortest distance from the midline were measured. Based upon the shape of the sphenoidal sinus separation, sellar floor was accurately localized in all cases. Intra-operative sphenoidal sinus separation was consistent with pre-operative 3D CT reconstruction images. The sellar floor was extremely small in two patients, and insufficient fenestration of the sellar floor negatively affected tumor resection. Pre-operative 3D CT reconstruction is helpful for accurate and rapid localization of the saddle floor. The anatomic variation of sphenoidal sinus and adjacent structures, the characteristics of tumor and Sella, the minimum distance between bilateral CSICA and the shortest distance from the midline are helpful for the establishment of individualized Sellar bottom fenestration. Copyright © 2018. Published by Elsevier Inc.

Three-dimension visualization of transnasal approach for revealing the metasellar organization

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Liang XUE

2012-07-01

Full Text Available Objective To elevate the anatomical cognitive level by investigating the metasellar organization viatransnasal approach in a virtual-reality (VR setting. Methods Twenty-eight patients, with spontaneous subarachnoid hemorrhage but without pathological changes of nasal cavity and sella turcica, underwent the lamellar imaging examination and CT angiogram with Discovery Ultra 16. The data were collected and entered in the Dextroscope in DICOM format. Visualization research was carried out viathe transnasal approach in a virtual-reality (VR setting. Results The anatomic structures of transnasal approach were allowed to be observed dynamically and spatially. When exposing the lateral border of cavernous carotid artery, it was important to excise the ethmoid cornu, open posterior ethmoid sinus and sphenopalatine foramen, control sphenopalatine artery, properly drill out pterygoid process and reveal pterygoid canal. Conclusion It is the key point to remove the ethmoid cornu, uncinate process and bone of the anterior region of sphenoidal sinus, and control sphenopalatine artery viatransnasal approach to expose the metasellar structure. The cavernous carotid arteries are the most important anatomic structure, should be adequately exposed and conserved.

Fat-suppressed dynamic MR imaging for the postoperative evaluation of pituitary adenomas

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Akada, Kiyohiro

2000-01-01

The usefulness of the early post operative evaluation of pituitary adenomas with fat-suppressed MR imaging was studied. Thirty patients with pituitary adenoma, who underwent trans-sphenoidal surgery were analyzed. These include 22 with macroadenoma (3 recurrent cases) and 8 with microadenoma (2 recurrent cases). In all cases after adenoma resection, fat tissue was placed into the sella turcica to prevent postoperative cerebro-spinal fluid leakage and infections. T1-weighted and Gd DTPA-enhanced MR images were obtained using a 1.5-T superconductive MRI system (Shimadzu Co., Ltd.) by a standard technique and also by a fat suppression technique (chemical shift selective presaturation: CHESS) after surgery. It was difficult to discriminate between hematoma, fat tissue and pituitary posterior lobe on T1-weighted images within 1 month after surgery because of high-signal intensity. However, these regions could be distinguished one another by the CHESS technique. Normal pituitary anterior lobe could be identified in 86% of macroadenoma cases using Gd CHESS dynamic study, whereas it was identified only in 23% by standard technique. Normal anterior lobe was identified in 100% of microadenoma cases using Gd CHESS dynamic study. The residual tumors were found to invade into the supra sella or cavernous sinus, and these lesions could be distinguished from the surrounding tissue by the CHESS dynamic study in 83%, whereas only 33% could be distinguished by the standard technique. Although the fat tissue showed a time-sequence decrease in volume, high-signal intensity sometimes lasted long in association with degenerative granulation. In conclusion, CHESS dynamic MR Imaging study is useful for detection of the normal pituitary lobe and residual adenomas after trans-sphenoidal surgery. (author)

Cerebrospinal meningitis in a 30 -year -old patient as first manifestation of pituitary macroadenoma.

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Andrysiak -Mamos, Elżbieta; Żochowska, Ewa; Kaźmierczyk -Puchalska, Agnieszka; Sagan, Leszek; Sowińska -Przepiera, Elżbieta; Zając -Marczewska, Małgorzata; Kojder, Ireneusz; Syrenicz, Anhelli

The most common clinical and neurological signs and symptoms of pituitary macroadenomas include headache, vision impairment and cranial nerve palsy. The patient presented in this article was admitted to the Intensive Care Unit at regional hospital; at admission, the patient was unconscious, he had convulsions and spasms, and a 3 -day history of headache and body temperature up to 41.5°C. The patient with suspected neuroinfection was transferred to the Department of Infectious Diseases of the Pomeranian Medical University in Szczecin (PMU), where cerebrospinal meningitis of bacterial etiology was established based on cerebrospinal fluid investigations and the presence of pituitary abscess was suggested based on magnetic resonance imaging (MRI). Magnetic resonance imaging findings included an extensive pathological lesion with the diameter of 27 × 28 × 38 mm located in the sellar-suprasellar region, with intensive peripheral contrast enhancement. The lesion protrudes into the sphenoid sinus through the lowered bottom of sella turcica and the fluid content has also been visualized in the sphenoid sinus. After 10 -day antibiotic therapy, the patient was transferred to neurosurgery ward for surgical treatment. The pathological lesion was partially evacuated during right frontotemporal craniotomy. The patient’s general condition after the surgery was moderately severe; the patient was conscious, able to follow simple commands, presenting hemiparesis of the left side of the body, particularly affecting left lower limb and with speech disturbances. The signs of hypopituitarism affecting all hormonal axes were also observed and the patient was transferred to the Department of Endocrinology of the PMU for further treatment. Follow -up MRI scan continued to show the presence of pathological mass in the sellar -suprasellar region, which penetrated into the sphenoid sinus through damaged sellar bottom. After correction of reduced hormone levels and several weeks of

Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas.

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Khan, Osaama H; Krischek, Boris; Holliman, Damian; Klironomos, George; Kucharczyk, Walter; Vescan, Allan; Gentili, Fred; Zadeh, Gelareh

2014-06-01

The expanded endoscopic endonasal (EEE) approach for the removal of olfactory groove (OGM) and tuberculum sellae (TSM) meningiomas is currently becoming an acceptable surgical approach in neurosurgical practice, although it is still controversial with respect to its outcomes, indications and limitations. Here we provide a review of the available literature reporting results with use of the EEE approach for these lesions together with our experience with the use of the endoscope as the sole means of visualization in a series of patients with no prior surgical biopsy or resection. Surgical cases between May 2006 and January 2013 were retrospectively reviewed. Twenty-three patients (OGM n=6; TSM n=17) were identified. In our series gross total resection (GTR) was achieved in 4/6 OGM (66.7%) and 11/17 (64.7%) TSM patients. Vision improved in the OGM group (2/2) and 8/11 improved in the TSM group with no change in visual status in the remaining three patients. Post-operative cerebrospinal fluid (CSF) leak occurred in 2/6 (33%) OGM and 2/17 (11.8%) TSM patients. The literature review revealed a total of 19 OGM and 174 TSM cases which were reviewed. GTR rate was 73% for OGM and 56.3% for TSM. Post-operative CSF leak was 30% for OGM and 14% for TSM. With careful patient selection and a clear understanding of its limitations, the EEE technique is both feasible and safe. However, longer follow-ups are necessary to better define the appropriate indications and ideal patient population that will benefit from the use of these newer techniques. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Gross tumor volume (GTV) and clinical target volume (CTV) for radiation therapy of benign skull base tumours

International Nuclear Information System (INIS)

Maire, J.P.; Liguoro, D.; San Galli, F.

2001-01-01

Skull base tumours represent a out 35 to 40% of all intracranial tumours. There are now many reports in the literature confirming the fact that about 80 to 90% of such tumours are controlled with fractionated radiotherapy. Stereotactic and 3-dimensional treatment planning techniques increase local control and central nervous system tolerance. Definition of the gross tumor volume (GTV) is generally easy with currently available medical imaging systems and computers for 3-dimensional dosimetry. The definition of the clinical target volume (CTV) is more difficult to appreciate: it is defined from the CTV plus a margin, which depends on the histology and anterior therapeutic history of the tumour. It is important to take into account the visible tumour and its possible extension pathways (adjacent bone, holes at the base of skull) and/or an anatomic region (sella turcica + adjacent cavernous sinus). It is necessary to evaluate these volumes with CT Scan and MRI to appreciate tumor extension in a 3-dimensional approach, in order to reduce the risk of marginal recurrences. The aim of this paper is to discuss volume definition as a function of tumour site and tumour type to be irradiated. (authors)

Ectopic sphenoid sinus pituitary adenoma (ESSPA) with normal anterior pituitary gland: a clinicopathologic and immunophenotypic study of 32 cases with a comprehensive review of the english literature.

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Thompson, Lester D R; Seethala, Raja R; Müller, Susan

2012-03-01

Ectopic sphenoid sinus pituitary adenoma (ESSPA) may arise from a remnant of Rathke's pouch. These tumors are frequently misdiagnosed as other neuroendocrine or epithelial neoplasms which may develop in this site (olfactory neuroblastoma, neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, paraganglioma, melanoma). Thirty-two patients with ESSPA identified in patients with normal pituitary glands (intact sella turcica) were retrospectively retrieved from the consultation files of the authors' institutions. Clinical records were reviewed with follow-up obtained. An immunohistochemical panel was performed on available material. Sixteen males and 16 females, aged 2-84 years (mean, 57.1 years), presented with chronic sinusitis, headache, obstructive symptoms, and visual field defects, although several were asymptomatic (n = 6). By definition, the tumors were centered within the sphenoid sinus and demonstrated, by imaging studies or intraoperative examination, a normal sella turcica without a concurrent pituitary adenoma. A subset of tumors showed extension into the nasal cavity (n = 5) or nasopharynx (n = 9). Mean tumor size was 3.4 cm. The majority of tumors were beneath an intact respiratory epithelium (n = 22), arranged in many different patterns (solid, packets, organoid, pseudorosette-rosette, pseudopapillary, single file, glandular, trabecular, insular). Bone involvement was frequently seen (n = 21). Secretions were present (n = 16). Necrosis was noted in 8 tumors. The tumors showed a variable cellularity, with polygonal, plasmacytoid, granular, and oncocytic tumor cells. Severe pleomorphism was uncommon (n = 5). A delicate, salt-and-pepper chromatin distribution was seen. In addition, there were intranuclear cytoplasmic inclusions (n = 25) and multinucleated tumor cells (n = 18). Mitotic figures were infrequent, with a mean of 1 per 10 HPFs and a pituitary hormones included 48% reactive for 2 or more hormones (plurihormonal), and

Pituitary tumour causing gigantism. Morphology and in vitro hormone secretion.

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Anniko, M; Ritzén, E M

1986-01-01

True gigantism with overproduction of growth hormone (GH) and prolactin (PRL) was diagnosed in a 13-year-old boy. The clinical history indicated that the tumour had caused an oversecretion of GH since the age of 4-5 years. At diagnosis, the sella turcica was markedly enlarged. No infiltrative growth was noted at surgery. Endocrine investigations showed elevated GH and PRL secretion. Light and electron microscopy of tumour tissue revealed densely packed pleomorphic cells of both GH and PRL type. In addition, oncocyte-like cells were observed. Organ culture of pieces of tumour tissue demonstrated continued secretion of GH and PRL into the medium for more than 5 days in vitro. Addition of bromocriptine to the medium caused a rapid decline in PRL secretion while GH secretion remained the same. X-ray irradiation in vitro also caused a decrease in PRL secretion. These effects of bromocriptine and X-ray on hormone secretion in vitro mirrored the corresponding effect of treatment, when the patient showed signs of tumour recurrence after pituitary surgery. It is concluded that also in childhood, the in vitro response of tumour tissue to various treatments may be explored as a possible way to predict the efficacy of pharmacological or irradiation treatment of pituitary tumours.

Cushing-type ectopic pituitary adenoma with unusual pathologic features

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Kristopher T. Kimmell, MD

2014-06-01

Full Text Available Ectopic pituitary adenomas comprise, by varying reports, approximately 1-2% of all pituitary adenomas. They are often located in the nasopharyngeal region associated with the pharyngeal pituitary. The location and pathologic features of these masses make them atypical when compared with intrasellar pituitary adenomas. A 54-year-old man presented with vertebral compression fracture and physical stigmata of Cushing’s disease. Biochemical testing confirmed hypercortisolemia responsive to high dose dexamethasone suppression. MRI of the head demonstrated an enhancing mass in the posterior aspect of the sphenoid sinus not involving the sella turcica. Endoscopic biopsy followed by resection confirmed this mass to be a pituitary adenoma with unusual pathologic features. Most notably, the tumor cells demonstrated large, eosinophilic, vacuolated cytoplasm. Immunohistochemical profile of the tumor was typical of an ACTH secreting tumor, notably with positivity for ACTH. The patient did well from his surgery. Post-operatively his serum cortisol level normalized and he remains in chemical remission one year after surgery. Ectopic pituitary adenomas are an unusual manifestation of hormonally active pituitary neoplastic disease. Their atypical clinical presentations, location, and pathologic features can make them a diagnostic challenge. Clinicians should be aware of these entities, especially when considering differential diagnosis for a mass in the sphenoid sinus and nasopharyngeal region.

Anterior Hypopituitarism and Treatment Response in Hunter Syndrome: A Comparison of Two Patients

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Munier A. Nour

2016-01-01

Full Text Available Hypopituitarism is a clinically important diagnosis and has not previously been reported in Hunter syndrome. We contrast two cases with anatomic pituitary anomalies: one with anterior panhypopituitarism and the other with intact pituitary function. Patient 1, a 10-year-old boy with Hunter syndrome, was evaluated for poor growth and an ectopic posterior pituitary gland. Endocrine testing revealed growth hormone (GH deficiency, secondary adrenal insufficiency, and tertiary hypothyroidism. An improvement in growth velocity with hormone replacement (GH, thyroxine, and corticosteroid was seen; however, final adult height remained compromised. Patient 2, a 13-year-old male with Hunter syndrome, was evaluated for growth failure. He had a large empty sella turcica with posteriorly displaced pituitary. Functional endocrine testing was normal and a trial of GH-treatment yielded no significant effect. Panhypopituitarism associated with pituitary anomalies has not been previously reported in Hunter syndrome and was an incidental finding of significant clinical importance. In the setting of documented anterior hypopituitarism, while hormone replacement improved growth velocity, final height remained impaired. In patient 2 with equivocal GH-testing results, treatment had no effect on linear growth. These cases highlight the importance of careful clinical assessment in Hunter syndrome and that judicious hormone replacement may be indicated in individual cases.

Acromegaly: Role of Surgery in the Therapeutic Armamentarium

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Gerardo Guinto

2012-01-01

Full Text Available Acromegaly is a complex disease that requires the intervention of a multidisciplinary team. The most frequent clinical manifestations are growing of distal parts of the body and some areas of the face. Patients may also present arterial hypertension, diabetes mellitus, colonic polyps, cardiomegaly, neurological and endocrine changes secondary to the presence of a GH-secreting tumor in pituitary or extrapituitary origin, or eutopic hypothalamic GHRH hypersecretion and peripheral GHRH hypersecretion. Surgery is the first treatment used for most patients, regardless of the cause. In the great majority of cases, pituitary tumor can be removed through a transsphenoidal approach. Craniotomy is reserved for those cases with giant tumors, particularly when they grow toward the middle or posterior cranial fossa. Best surgical results are obtained when the tumor is confined into the sella turcica or if it has a regular suprasellar extension. When the disease cannot be controlled with surgery, medical treatment is indicated. Somatostatin analogues are included as the first line of medication, followed by dopamine agonist and growth hormone receptors antagonists. Radiation therapy can be also indicated in two main forms for residual tumor with medically refractory patients: radiosurgery for small tumors or fractionated stereotactic radiotherapy for larger ones.

Tuberculum sellae meningiomas: surgical considerations Meningiomas do tuberculo selar: aspectos cirúrgicos

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José Alberto Landeiro

2010-06-01

Full Text Available We report our experience on the treatment of tuberculum sellae meningiomas (TSMs regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.Apresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal �

Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation

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Rodriguez, O. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Mateos, B. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Pedraja, R. de la [Servicio de Endocrinologia, Hospital de Cruces, Baracaldo (Spain); Villoria, R. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Hernando, J.I. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Pastor, A. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Pomposo, I. [Servicio de Neurocirugia, Hospital de Cruces, Baracaldo (Spain); Aurrecoechea, J. [Servicio de Neurocirugia, Hospital de Cruces, Baracaldo (Spain)

1996-11-01

Our purpose was to correlate the morphological changes seen on MRI studies of the sellar region after trans-sphenoidal resection of pituitary adenomas with clinical and hormonal studies. Between January 1993 and March 1994, 16 patients with a pituitary adenoma (9 macroadenomas and 7 microadenomas) were subjected to trans-sphenoidal resection and included in a prospective study. The protocol consisted of MRI, hormonal and visual studies at the following times: immediately postoperative (1st week), 1st month, 4th month and 1st year after surgery. The evolution of the contents of the sella turcica (tumour remnant, packing material and gland tissue), effects on the infundibulum, optic chiasm, cavernous sinus and sphenoid sinus were correlated with the clinical and hormonal studies. Stabilisation of the postsurgical changes occurred by the 4th month. Tumour remnants were noted in the immediate postoperative period in macroadenomas. Compression of the infundibulum was the only reliable indicator of possible involvement. Optic chiasm compression, defined as close contact between the chiasm and the tumour, was the only morphological finding that indicated visual impairment. There was no standard repneumatisation pattern in the sphenoid sinus, since mucosal changes resembling sinusitis were one of the postsurgical changes. We found MRI not to be useful for follow-up of microadenomas. (orig.). With 4 figs., 4 tabs.

Patients cured of acromegaly do not experience improvement of their skull deformities.

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Rick, Jonathan W; Jahangiri, Arman; Flanigan, Patrick M; Aghi, Manish K

2017-04-01

Acromegaly is a rare disease that is associated with many co-morbidities. This condition also causes progressive deformity of the skull which includes frontal bossing and cranial thickening. Surgical and/or medical management can cure this condition in many patients, but it is not understood if patients cured of acromegaly experience regression of their skull deformities. We performed a retrospective analysis on patients treated at our dedicated pituitary center from 2009 to 2014. We looked at all MRI images taken during the treatment of these patients and recorded measurements on eight skull dimensions. We then analyzed these measurements for changes over time. 29 patients underwent curative treatment for acromegaly within our timeframe. The mean age for this population was 45.0 years old (range 19-70) and 55.2 % (n = 16) were female. All of these patients were treated with a transsphenoidal resection for a somatotropic pituitary adenoma. 9 (31.1%) of these patients required further medical therapy to be cured. We found statically significant variation in the coronal width of the sella turcica after therapy, which is likely attributable to changes from transsphenoidal surgery. None of the other dimensions had significant variation over time after cure. Patients cured of acromegaly should not expect natural regression of their skull deformities. Our study suggests that both frontal bossing and cranial thickening do not return to normal after cure.

Late onset isotretinoin resistant acne conglobata in a patient with acromegaly

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Jain Kapil

2008-01-01

Full Text Available A 55 year-old male presented with multiple pus-discharging abscesses and sinuses and mutilating scarring on the gluteal region and back prevalent for the last ten years with exacerbations and remissions. Physical examination revealed acromegaly with frontal bossing, prognathism, a barrel chest and acral hypertrophy. Dermatological examination revealed cutis verticis gyrata, thick eyelids, a large triangular nose, a thickened lower lip, macroglossia, widely spaced teeth and widened skin pores with wet and oily skin. Hair was fine and nails were flat and wide. There were multiple inflammatory papules, tender nodules, draining sinuses, and grouped, polyporous comedones as well as multiple and extensive depressed and keloidal scars localized predominantly over the gluteal region with a few scattered lesions over the back. A computed tomography (CT scan showed widened sella turcica. His basal fasting growth hormone (GH levels were markedly raised (230 ng/mL; normal 1-5 ng/mL while the prolactin levels were moderately raised (87 ng/mL; normal 2-5 ng/mL. These findings were consistent with a diagnosis of acromegaly. The patient was put on antibiotics, nonsteroidal antiinflammatory drugs and isotretinoin at a dose of 1 mg/kg/day, which was increased to 1.5 mg/kg/day. Except for an initial mildly beneficial response, the skin lesions were largely resistant to high doses of isotretinoin at the end of four months.

Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation

International Nuclear Information System (INIS)

Rodriguez, O.; Mateos, B.; Pedraja, R. de la; Villoria, R.; Hernando, J.I.; Pastor, A.; Pomposo, I.; Aurrecoechea, J.

1996-01-01

Our purpose was to correlate the morphological changes seen on MRI studies of the sellar region after trans-sphenoidal resection of pituitary adenomas with clinical and hormonal studies. Between January 1993 and March 1994, 16 patients with a pituitary adenoma (9 macroadenomas and 7 microadenomas) were subjected to trans-sphenoidal resection and included in a prospective study. The protocol consisted of MRI, hormonal and visual studies at the following times: immediately postoperative (1st week), 1st month, 4th month and 1st year after surgery. The evolution of the contents of the sella turcica (tumour remnant, packing material and gland tissue), effects on the infundibulum, optic chiasm, cavernous sinus and sphenoid sinus were correlated with the clinical and hormonal studies. Stabilisation of the postsurgical changes occurred by the 4th month. Tumour remnants were noted in the immediate postoperative period in macroadenomas. Compression of the infundibulum was the only reliable indicator of possible involvement. Optic chiasm compression, defined as close contact between the chiasm and the tumour, was the only morphological finding that indicated visual impairment. There was no standard repneumatisation pattern in the sphenoid sinus, since mucosal changes resembling sinusitis were one of the postsurgical changes. We found MRI not to be useful for follow-up of microadenomas. (orig.). With 4 figs., 4 tabs

Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing's disease

International Nuclear Information System (INIS)

Degerblad, M.; Raehn, T.; Bergstrand, G.; Thoren, M.

1986-01-01

Gamma radiation from 60 Co delivered with stereotactic technique was given to the pituitary gland in 35 patients, aged 18-65 years, with Cushing's disease. The doses were 70-100 Gy in each single irradiation. The size of the sella turcica was normal in the majority of the patients. The observation time was 3-9 years in 29 patiens. Out of them, 14 (48%) obtained clinical remission and normal urinary cortisol after one irradiation. Eight achieved remission after two to four irradiations. In total, 22 out of 29 patients (76%) obtained remission. In 12 of them remission was obtained in 1 year and in another 10 within 3 years. No recurrences were observed. Improvement was seen in 2 patients after one and three irradiations. Bilateral adrenalectomy was performed in 5 patients owing to unsatisfactory effect of irradiation. Pituitary insufficiency with gonadotropin, thyrotropin or cortocotropin failure was demonstrated in 12 of 22 patients in remission. This occurred 4 months to 7 years after the first irradiation. Another 6 patients were followed less than 3 years after the first irradiation. Two obtained remission after the first treatment, whereas the other 4 improved. Stereotactic pituitary irradiation is suggested as a non-invasive therapeutic alternative in Cushing's disease for example in patients with considerable surgical risk or as a supplement to pituitary microsurgery. (author)

[Dwarfism due to familial panhypopituitarism].

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Cos Welsh, J; Espinosa de los Monteros, A; de la Luz Ajuria, M; Morillo Almao, E

1977-01-01

Three sisters of 27 7/12, 13 8/12 and 9 1/12 years of age, respectively, with proportionate dwarfism, high pitched voice and lack of sexual development are described. All the patients had very low serum levels of immunoreactive growth hormone (GH), as well as of LH and FSH. Hypoglycemia induced by insulin and arginine infusion failed to increase GH levels, and the administration of the hypothalamic LH-FSH releasing hormone (LH-RH) did not elicit any response in the secretion of gonadotropins. The oldest sister developed hypothyroidism in recent years, since the I131 thyroid uptake was normal ten years before; her serum TSH was low and did not change with TRH stimulation. In addition, a low pituitary ACTH reserve was demonstrated by the hypoglycemia and metirapone tests. Case 2 showed partial pituitary TSH and ACTH reserve, whereas the youngest child only had low TSH pituitary reserve. These patients had all the clinical and laboratory characteristics of familial panhypopituitarism, with normal sella turcica. Genetic transmission in this cases is consistent with the autosomal recessive form, which is the most frequent type of inheritance of this entity. Consanguinity can not be ruled out. The results of the hypothalamic-pituitary functional tests apparently suggest that the primary defect could be located at the pituitary level. It is also possible that the pathological process may have a progressive evolution.

Spindle cell oncocytoma of adenohypophysis: Cytogenetics and β-catenin findings with pathology differential diagnosis and review of the literature

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Jianwu Xie

2017-09-01

Full Text Available Spindle cell oncocytoma (SCO is an extremely rare neoplasm arising in the anterior pituitary. We report comprehensive pathological description of a case of SCO in a 60 year-old male who presented with nausea, vomiting and severe hyponatremia, and pan hypopituitarism. Magnetic resonance imaging (MRI showed a 3.1 × 2.3 × 2.0 cm homogeneously enhancing bilobed mass within the sella turcica and suprasellar cistern. Intraoperative frozen section and touch imprint cytology showed cohesive spindle cells with abundant oncocytic cytoplasm. Histologic sections revealed the tumor was composed of interlacing fascicles of compact spindled cells with abundant dense oncocytic cytoplasm. There was no mitosis or necrosis present. Ki-67 index varied in areas, with an average of 3%. By immunohistochemistry (IHC, the tumor cells were negative for Cam5.2, AE1/3, neurofilament (NF, NeuN, glial fibrillary acidic protein (GFAP and synaptophysin, and strongly positive for vimentin, TTF-1 and EMA. S-100 showed focal weakly positivity. By electron microscopy (EM, the cytoplasm of the spindle cells contained numerous abundant, back-to-back, uniform, round, normal-sized mitochondria with long and lamellar cristae. Beta-catenin showed diffuse membranous and partial cytoplasmic positivity. Cytogenetic analysis showed extra copies of chromosome 1 (74%, up to 8 copies, and loss of chromosome 2 (35%. The histogenesis, classification and differential diagnosis are discussed.

Aspectos de interés sobre el síndrome de silla turca vacía en los niños: a propósito de 5 pacientes Aspects of interest on the empty sella syndrome in children: apropos of 5 patients

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Pedro González Fernández

2008-06-01

Full Text Available Se presentan 5 pacientes menores de 12 años, atendidos en el Servicio de Endocrinología del Hospital Pediátrico Docente «William Soler» a quienes se les realizó un estudio imagenológico con tomografía axial computada y resonancia magnética nuclear, para confirmar diagnóstico de endocrinopatía. Tras el estudio se diagnosticó síndrome de la silla turca vacía. Existen diferencias clínicas entre niños y adultos con silla turca vacía; las más relevantes radican en que en los niños no hay predominio de sexo ni asociación con la obesidad, y en ellos se observa la presencia de afecciones endocrinas como expresión de alteraciones hipotálamo-hipofisarias.The cases of 5 patients under 12 that received attention at the Endocrinology Service of "William Soler" Pediatric Teaching Hospital and that underwent an imaging study with computerized axial tomography and nuclear magnetic imaging to confirm endocrinopathy were presented. The empty sella syndrome was diagnosed after concluding the study. Clinical differences were observed between children and adults with empty sella syndrome. The most significant were found in children, among whom there was neither predominance of sex nor association with obesity. The presence of endocrine affections as expression of hypothalamus-hypophyseal alterations was observed in them.

Gorlin-Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature.

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Lata, Jeevan; Verma, Nitin; Kaur, Amandeep

2015-09-01

In Indian scenario, Gorlin-Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. The diagnostic findings of Gorlin-Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested.

Application of phantom type compensating filter in tomography

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Okayama, A.; Mukae, H.; Itoh, M. (Yamaguchi Univ., Ube (Japan). School of Medicine)

1981-01-01

We reported a new device of phantom type compensating filters for pulmonary hilar tomography with polytome U at the 35th annual meeting of the Japanese Society of Radiological Technology. This report is to show application of this compensated method to the head, the hip joint and the lower thoracic spine in tomography. Using the filters optimal density can be obtained in all area of aim part on a X-ray film, and thus makes to get more information. 1) In the head clear shadow of pars nasalis, sinus paranasales and sella turcica is obtained. Destruction or defect of bone contour is easily detected. It is also useful to differentiate the disorders and to determine the expansivity of the lesion. 2) In the hip joint this method has advantages over the ordinary method. There is a few misdiagnosis in trochanteric lesions such as tuberculosis or bone tumor, because of high density at the trochanteric region in ordinary method, but in this method optimal density can be obtained, and misdiagnosis is improved. Soft tissue is sharply visualized, indicating usefulness in diagnosis of existence of hematoma or abscess. 3) In the lower thoracic vertebra it is useful to diagnosis of the thoracic spondylosis, tuberculous spondylitis and compression fracture of the vertebral body, since optimal density of the spine can be obtained. It is also quite useful to detect small ossifications in the vertebral foraman in ossification of the flavum ligament.

Application of phantom type compensating filter in tomography

International Nuclear Information System (INIS)

Okayama, Akio; Mukae, Hideki; Itoh, Mitsuo

1981-01-01

We reported a new device of phantom type compensating filters for pulmonary hilar tomography with polytome U at the 35th annual meeting of the Japanese Society of Radiological Technology. This report is to show application of this compensated method to the head, the hip joint and the lower thoracic spine in tomography. Using the filters optimal density can be obtained in all area of aim part on a X-ray film, and thus makes to get more information. 1) In the head clear shadow of pars nasalis, sinus paranasales and sella turcica is obtained. Destruction or defect of bone contour is easily detected. It is also useful to differentiate the disorders and to determine the expansivity of the lesion. 2) In the hip joint this method has advantages over the ordinary method. There is a few misdiagnosis in trochanteric lesions such as tuberculosis or bone tumor, because of high density at the trochanteric region in ordinary method, but in this method optimal density can be obtained, and misdiagnosis is improved. Soft tissue is sharply visualized, indicating usefulness in diagnosis of existence of hematoma or abscess. 3) In the lower thoracic vertebra it is useful to diagnosis of the thoracic spondylosis, tuberculous spondylitis and compression fracture of the vertebral body, since optimal density of the spine can be obtained. It is also quite useful to detect small ossifications in the vertebral foraman in ossification of the flavum ligament. (author)

Unusual association of turner syndrome and hypopituitarism in a Tunisian family.

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Bougacha-Elleuch, N; Elleuch, M; Charfi, N; Mnif, F; Belghith, N; Abdelhedi, F; Kammoun, H; Hachicha, M; Mnif, M; Abid, M

2016-01-01

Familial occurrence of either Turner syndrome or hypopituitarism is very rare. Particularly, their association is an uncommon finding. In this context, we describe for the first time 4 sisters with Turner syndrome, hypopituitarism was reported in three among them. Our cohort consists of four Tunisian adult sisters belonging to a consanguineous family. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed. Turner syndrome was diagnosed at the ages of 14, 17, 31 and 43 years in cases 1, 2, 3 and 4 respectively. They suffered from short stature, dysmorphic syndrome and/or delayed puberty. Interestingly, 3 among them showed also hypopituitarism, hypogonadotrophic hypogonadism and central hypothyroidism. Somatotropic insufficiency was proven in one case. Pituitary MRI has shown an empty sella turcica with hypoplastic pituitary gland in three cases. Their karyotypes were compatible with 45X in one case, 45X/46XX in the second and 45X/46XX/47XXY with x label in two cases. Hence, the presence of these familial cases of TS must evoke new etiopathogenetic arguments. Coincidence of hypopituitarism in this family, might suggest common genetic background for the two diseases. This particular family would be a precious tool for an extensive molecular analysis. More attention should be given to other family's members mainly in the presence of delayed puberty and sterility in other members. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Pituitary abscess: report of two cases and review of the literature

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Liu Y

2017-06-01

Full Text Available Yu Liu,1 Feng Liu,2 Qi Liang,3 Yexin Li,4 Zhifei Wang5 1Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 2Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 3Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 4Department of Neurosurgery, The Central Hospital of Shaoyang, Shaoyang, 5Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China Abstract: Pituitary abscess is a rare but critical disorder caused by an infectious process where purulent material accumulates inside the sella turcica. Since symptoms, signs and radiographic characteristics of pituitary abscess are similar to several other pituitary lesions, correct diagnosis before surgery is challenging. In this article, two cases of pituitary abscess treated in our department are reported, followed by a literature review. In these two cases, both patients presented with intermittent fever. Magnetic resonance imaging revealed a suprasellar lesion with rim enhancement after contrast injection. After transsphenoidal surgery, the diagnosis of pituitary abscess was confirmed. The patients were then given antibiotic treatment and recovered fully in less than 2 months. Findings of this article support timely diagnosis and proper treatment including transsphenoidal surgery and antibiotic therapy for pituitary abscess, leading to lower mortality rates and higher probability of pituitary hormone function recovery. Keywords: pituitary abscess, transsphenoidal resection, antibiotic therapy, diagnosis 

Changes in Plasma Prolactin and Growth Hormone Level and Visual Problem after radiation Therapy(RT) of Pituitary Adenoma

International Nuclear Information System (INIS)

Yoon, Sei Chul; Kwon, Hyung Chul; Oh, Yoon Kyeong; Bahk, Yong Whee; Son, Ho Young; Kang, Joon Ki; Song, Jin Un

1985-01-01

Twenty-four cases of pituitary adenoma, 13 males and 11 females with the age ranging from 11 to 65 years, received radiation therapy(RT) on the pituitary area with 6MV linear accelerator during past 25 months at the Division of Radiation Therapy, Kangnam St. Mary Hospital, Catholic Medical College. Of 24 case of RT, 20 were postoperative and 4 primary. To evaluate the effect of RT, we analyzed the alteration of the endocrinological tests, neurologic abnormalities, major clinical symptoms, endocrinological changes and improvement in visual problems after RT. The results were as follows ; 1. Major clinical symptoms were headache, visual defects, diabetes insipidus, hypogonadisms and general weakness in decreasing order of frequency. 2. All but the one with Nelson syndrome showed abnormal neuroradiologic changes in the sella turcica with an invasive tumor mass around supra and para-sellar area. 3. Endocrinological classifications of the patient were 11 prolactinoma, 4 growth hormonesecreting tumors, 3 ACTH-secreting tumors consisting of one Cushing disease and two Nelson syndrome, and 6 nonfunctioning tumors. 4. Eleven of 14 patients, visual problems were improved after treatment but remaining 3 were unchanged. 5. Seven of 11 prolactinomas returned to normal hormonal level after postoperative and primary RT and 3 patients are being treated with bromocriptine (BMCP) but on lost case. 6. Two of 4 growth hormone-secreting tumor returned to normal level after RT but the remaining 2 are being treated with BMCP, as well

Endoscopic transnasal repair of cerebrospinal fluid leaks with and without an encephalocele in pediatric patients: from infants to children.

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Ma, Jingying; Huang, Qian; Li, Xiaokui; Huang, Dongsheng; Xian, Junfang; Cui, Shunjiu; Li, Yunchuan; Zhou, Bing

2015-09-01

The diagnosis and management of pediatric cerebrospinal fluid (CSF) leak and encephalocele are challenging. The current study aimed to identify patient characteristics, review operative techniques, and evaluate the efficacy and safety of endoscopic endonasal repair in a pediatric population. We retrospectively reviewed the records of pediatric patients who underwent transnasal endoscopic repair of CSF leak with or without a meningocele or an encephalocele at Beijing Tongren Hospital, Capital Medical University, between July 2003 and May 2014. All patients had preoperative radiological evaluations and underwent endoscopic endonasal repair of their skull base defects. Altogether, 23 children (mean age 7.0 years) underwent the procedures. Sixteen cases were congenital, and 7 patients had trauma history. The herniations or defects included meningoencephaloceles in 15 cases, meningoceles in 4 cases, and CSF leak in 4 cases (2 patients had bilateral leaks). The leak or herniation sites were ethmoid roof in 10 patients (one was bilateral), cribriform plate in 5, lateral to the foramen cecum in 3, posterior wall of the frontal sinus in 1, sphenoid sinus in 2, lateral recess of the sphenoid sinus in 1, and sella turcica base in 2. All subjects had favorable clinical outcomes without recurrence during a follow-up of 6-123 months (mean 61.1 months). The endoscopic endonasal approach was the preferred method for repairing CSF leaks with or without an encephalocele in pediatric patients. Compared to traditional operations, this endoscopic procedure is minimally invasive, efficient, and safe.

Posterior cranial base natural growth and development: A systematic review.

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Currie, Kris; Sawchuk, Dena; Saltaji, Humam; Oh, Heesoo; Flores-Mir, Carlos; Lagravere, Manuel

2017-11-01

To provide a synthesis of the published studies evaluating the natural growth and development of the human posterior cranial base (S-Ba). The search was performed on MEDLINE, Embase, PubMed, and all EBM Reviews electronic databases. In addition, reference lists of the included studies were hand-searched. Articles were included if they analyzed posterior cranial-base growth in humans specifically. Study selection, data extraction, and risk of bias assessment were completed in duplicate. A meta-analysis was not justified. Finally, 23 published studies were selected: 5 cross-sectional and 18 cohort studies. Articles were published between 1955 and 2015, and all were published in English. The sample sizes varied between 20 and 397 individuals and consisted of craniofacial measurements from either living or deceased human skulls. Validity of the measurements was not determined in any of the studies, while six papers reported some form of reliability assessment. All the articles included multiple time points within the same population or data from multiple age groups. Growth of S-Ba was generally agreed to be from spheno-occipital synchondrosis growth. Basion displaced downward and backward and sella turcica moved downward and backward during craniofacial growth. Timing of cessation of S-Ba growth was not conclusive due to limited identified evidence. Current evidence suggests that S-Ba is not totally stable, as its dimensions change throughout craniofacial growth and a minor dimensional change is observed even in late adulthood.

The 360 photography: a new anatomical insight of the sphenoid bone. Interest for anatomy teaching and skull base surgery.

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Jacquesson, Timothée; Mertens, Patrick; Berhouma, Moncef; Jouanneau, Emmanuel; Simon, Emile

2017-01-01

Skull base architecture is tough to understand because of its 3D complex shape and its numerous foramen, reliefs or joints. It is especially true for the sphenoid bone whom central location hinged with most of skull base components is unique. Recently, technological progress has led to develop new pedagogical tools. This way, we bought a new real-time three-dimensional insight of the sphenoid bone that could be useful for the teacher, the student and the surgeon. High-definition photography was taken all around an isolated dry skull base bone prepared with Beauchêne's technique. Pictures were then computed to provide an overview with rotation and magnification on demand. From anterior, posterior, lateral or oblique views and from in out looks, anatomical landmarks and subtleties were described step by step. Thus, the sella turcica, the optic canal, the superior orbital fissure, the sphenoid sinus, the vidian canal, pterygoid plates and all foramen were clearly placed relative to the others at each face of the sphenoid bone. In addition to be the first report of the 360 Photography tool, perspectives are promising as the development of a real-time interactive tridimensional space featuring the sphenoid bone. It allows to turn around the sphenoid bone and to better understand its own special shape, numerous foramen, neurovascular contents and anatomical relationships. This new technological tool may further apply for surgical planning and mostly for strengthening a basic anatomical knowledge firstly introduced.

Effects of active acromegaly on bone mRNA and microRNA expression patterns.

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Belaya, Zhanna; Grebennikova, Tatiana; Melnichenko, Galina; Nikitin, Alexey; Solodovnikov, Alexander; Brovkina, Olga; Grigoriev, Andrey; Rozhinskaya, Liudmila; Lutsenko, Alexander; Dedov, Ivan

2018-04-01

To evaluate the response of bone to chronic long-term growth hormone (GH) and insulin-like growth factor-1 (IGF1) excess by measuring the expression of selected mRNA and microRNA (miR) in bone tissue samples of patients with active acromegaly. Case-control study. Bone tissue samples were obtained during transsphenoidal adenomectomy from the sphenoid bone (sella turcica) from 14 patients with clinically and biochemically confirmed acromegaly and 10 patients with clinically non-functioning pituitary adenoma (NFPA) matched by sex and age. Expression of genes involved in the regulation of bone remodeling was studied using quantitative polymerase chain reaction (qPCR). Of the genes involved in osteoblast and osteoclast activity, only alkaline phosphatase (ALP) mRNA was 50% downregulated in patients with acromegaly. GH excess caused increased expression of the Wnt signaling antagonists ( DKK1) and agonists ( WNT10B) and changes in the levels of miR involved in mesenchymal stem cell commitment to chondrocytes (miR-199a-5p) or adipocytes (miR-27-5p, miR-125b-5p, miR-34a-5p, miR-188-3p) P  Acromegaly had minimal effects on tested mRNAs specific to osteoblast or osteoclast function except for downregulated ALP expression. The expressions of miR known to be involved in mesenchymal stem cell commitment and downregulated TWIST1 expression suggest acromegaly has a negative effect on osteoblastogenesis. © 2018 European Society of Endocrinology.

Skull deformations in craniosynostosis and endocrine disorders: morphological and tomographic analysis of the skull from the crypt of the Silesian Piasts in Brzeg (16th-17th century), Poland.

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Kozłowski, T; Cybulska, M; Błaszczyk, B; Krajewska, M; Jeśman, C

2014-10-01

of morphological and tomographic (CT) studies of the skull that was found in the crypt of the Silesian Piasts in the St. Jadwiga church in Brzeg (Silesia, Poland) are presented and discussed here. The established date of burial of probably a 20-30 years old male was 16th-17th century. The analyzed skull showed premature obliteration of the major skull sutures. It resulted in the braincase deformation, similar to the forms found in oxycephaly and microcephaly. Tomographic analysis revealed gross pathology. Signs of increased intracranial pressure, basilar invagination and hypoplasia of the occipital bone were observed. Those results suggested the occurrence of the very rare Arnold-Chiari syndrome. Lesions found in the sella turcica indicated the development of pituitary macroadenoma, which resulted in the occurrence of discreet features of acromegaly in the facial bones. The studied skull was characterized by a significantly smaller size of the neurocranium (horizontal circumference 471 mm, cranial capacity ∼ 1080 ml) and strongly expressed brachycephaly (cranial index=86.3), while its height remained within the range for non-deformed skulls. A narrow face, high eye-sockets and prognathism were also observed. Signs of alveolar process hypertrophy with rotation and displacement of the teeth were noted. The skull showed significant morphological differences compared to both normal and other pathological skulls such as those with pituitary gigantism, scaphocephaly and microcephaly. Copyright © 2014 Elsevier GmbH. All rights reserved.

Alterações visuais decorrentes do cisto da fenda de Rathke: relato de caso Visual alterations due to Rathke's cleft cyst: case report

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Gustavo Valandro Rech

2004-12-01

provoke the symptoms. Clinically, the patients complain about blurred vision and they also present hemianopsia deficiency. M.A.S.R., 47 years old, female, white, born in Pelotas/RS, complained about progressive vision reduction in the right eye for 2 months. During the examination, loss of vision and bitemporal hemianopsia were discovered. Computerized tomography highlighted a rounded hypodense image with clear borders, in sellar topography, determining remodeling and enlarging of the sella turcica. Magnetic resonance showed expansive cystic injury located in the sella turcica with suprasellar growth. The mentioned injury presented obliteration in the suprasellar cistern and an important compression on the optic chiasm. The surgical approach confirmed the presence of extensive cystic injury compressing the optic chiasm, and the anatomicopathological examination of the material diagnosed Rathke's cleft cyst. The ophthalmic examination three months after the surgery showed improvement in visual accuracy and total recovery of defects of the visual field. Rathke's cleft cyst must be included in the differential diagnosis of parasellar tumors which may cause compression of optical pathway, and the importance of the diagnosis and immediate treatment with the purpose of avoiding structural damages with unreversible losses of visual function, as well as endocrine disorders are emphasized.

Significance of the sexual openings and supplementary structures on the phylogeny of brachyuran crabs (Crustacea, Decapoda, Brachyura), with new nomina for higher-ranked podotreme taxa.

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Guinot, Danièle; Tavares, Marcos; Castro, Peter

2013-01-01

coxal to coxo-sternal conditions. The coxo-sternal condition is not an intermediate towards the thoracotreme organisation, and a step in heterotreme evolution is the adoption of the coxo-sternal condition. An extreme carcinisition may also result in the sternal arrangement of male gonopores in the form of a "sternitreme" disposition, as in the case of Hymenosomatoidea, which displays a broad thoracic sternum and true sternal male gonopores (as in thoracotremes) together with several plesiomorphic traits that are assumed to represent an old, deeply-rooted heterotreme clade. A sternitreme condition evolved independently in the most ancestral heterotreme clades (such as Hymenosomatoidea) and in Thoracotremata. The older the lineage of a heterotreme is, the higher the possibility of having evolved carcinisation. Evidence that "derived" traits may be the consequence of a strong carcinisation, rather than being recently acquired, necessitates reconsidering certain character states in Brachyura. Eubrachyurans can only evolve either the heterotreme or the thoracotreme arrangement, the consistency of the inferred ancestral characters states providing a useful criterion for evaluating ancestral trait reconstructions. A widened thoracic sternum together with sternal gonopores may be present in carcinised heterotremes such as hymenosomatoids. The thoracic sternum provides a reliable complex of characters that must be carefully interpreted. The hypothesis of a coxo-sternal disposition in Cryptochiroidea and Pinnotheroidea, generally considered thoracotremes, is rejected, and an alternative interpretation of their status is discussed. A new interpretation of the phylogeny of Cryptochiroidea is outlined, but the origin of Pinnotheroidea remains puzzling. The sella turcica, frequently regarded a synapomorphy of Eubrachyura, is redefined as the structure formed by the endosternal intertagmal phragma that connects the tagma/thorax and the tagma/abdomen to thoracic interosternite 7/8. It

Gorlin–Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature

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Lata, Jeevan; Verma, Nitin; Kaur, Amandeep

2015-01-01

Objective: In Indian scenario, Gorlin–Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. Materials and Methods: The diagnostic findings of Gorlin–Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. Results: The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Conclusions: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested. PMID:26604574

Gorlin–Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature

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Jeevan Lata

2015-01-01

Full Text Available Objective: In Indian scenario, Gorlin–Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS] has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. Materials and Methods: The diagnostic findings of Gorlin–Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. Results: The most common features seen were keratocystic odontogenic tumors (100%, calcifications of falx cerebri (60%, palmar-plantar pits (80%, rib anomalies (80%, macroencephaly (60%, ocular hypertelorism (80%, and frontal bossing (60% in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Conclusions: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested.

Diabetes insipidus as the first symptom caused by lung cancer metastasis to the pituitary glands: Clinical presentations, diagnosis, and management

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J F Mao

2011-01-01

Full Text Available Background : Central diabetes insipidus (CDI, secondary to pituitary metastatic lesions, is uncommon; however, lung and breast cancer are the commonest malignancies to have metastases to the pituitary. Early management of systemic chemotherapy and pituitary irradiation might improve the prognosis of patients. Aims : To investigate the clinical features, diagnosis, and management of CDI caused by lung cancer metastasis to the pituitary glands. Materials and Methods : We retrospectively reviewed 10 patients who had CDI as their first symptom before their lung cancers were diagnosed. Their clinical presentations, anterior pituitary gland function, sellar magnetic resonance imaging (MRI, management, and prognosis were described. Settings and Design : This retrospective cross-sectional clinical study was conducted in a medical college hospital. Results : The patient′s mean age was 58.6±7.8 years. Diabetes insipidus was the main complaint when they were referred to our hospital. MRI revealed specific dumbbell-shaped masses in the sella turcica in five patients. In seven patients whose hormones were measured, the levels of hormones from adenohypophysis were abnormally low in six patients. The main treatments included surgery, systemic chemotherapy, and sellar irradiation. Although nine patients had poor prognoses, one patient has survived for more than 3 years, suggesting benefit from early diagnosis and treatment. Conclusions : New-onset CDI might be the only symptom presented by the patients with pituitary metastasis (PM from lung cancer. Dumbbell-shaped sellar masses in MRI are prone to the diagnosis of PM. A thorough examination for primary cancer should be carried out in these aged and elderly patients.

A practical 3D printed simulator for endoscopic endonasal transsphenoidal surgery to improve basic operational skills.

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Wen, Guodao; Cong, ZiXiang; Liu, KaiDong; Tang, Chao; Zhong, Chunyu; Li, Liwen; Dai, XuJie; Ma, Chiyuan

2016-06-01

We aimed to present a practical three-dimensional (3D) printed simulator to comprehensively and effectively accelerate the learning curve of endoscopic endonasal transsphenoidal surgery (EETS). The 3D printed simulator consists of three parts: (1) skull frame, (2) the nasal passage and the nasal alar of the face, and (3) a modified sella turcica. We aimed to improve three basic operational skills of surgeons: drilling, curetting, and aspirating. Eighteen neurosurgeons and five post-graduates were recruited and consented for the training. For trainees, (1) as the training progressed, the scores increased gradually, (2) a significant increase in the average scores was observed in the tenth training compared to the first training, and (3) there is a significant decrease in trainee variability in the shortening of the gap. The 18 neurosurgeons were divided into three groups: experts, assistants, and observers. For all three basic operations, (1) the average score of experts was obviously higher than that of the assistants, observers, and trainees' tenth training and (2) the average scores of assistants and observers were obviously higher than that of trainees' first training. A significant high in the average score between the assistants and the observers was seen for aspirating, but not for drilling or curetting. For curetting and aspirating, the tenth training average score of trainees was obviously higher than that of assistants and observers. This 3D printed simulator allows different endoscopic basic operations to be simulated and improves the EETS techniques of surgeons. We believed it to be a practical, simple, and low-cost simulator.

Pituitary abscess following transsphenoidal surgery: the experience of 12 cases from a single institution.

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Wang, Lei; Yao, Yong; Feng, Feng; Deng, Kan; Lian, Wei; Li, Guilin; Wang, Renzhi; Xing, Bing

2014-09-01

To explore possible reasons for the incidence of a pituitary abscess following transsphenoidal surgery and determine the most effective treatment. A series of 12 patients who had undergone transsphenoidal surgery in other hospitals before being treated at Peking Union Medical College Hospital were reviewed. The presence of a pituitary abscess was confirmed when pus was intraoperatively observed within the sella turcica. All patients were treated with debridement of the abscess, nine among whom through a transsphenoidal approach and the other three via a craniotomy, followed by antibiotic treatment and hormone replacement therapy. The mean follow-up time was 27.0 months (range from 3.0 to 79.0 months). Headache (92%), panhypopituitarism (58%) and visual disturbance (50%) were the most common clinical indicators of a pituitary abscess. Imaging tests demonstrated a pituitary mass in all patients, with seven (58%) manifested with typical magnetic resonance features of an abscess. Ten patients (83%) were correctly diagnosed preoperatively. During surgical exploration, six presented with severe inflammation or an abscess within the sphenoidal sinus. Causative organisms were identified in five patients (42%). After surgical and antibiotic therapies, all patients fully recovered except for two presenting with severe visual impairment. Six patients (50%) required hormone replacement therapy. Retrograde infection from the sphenoid sinus may be a vital mechanism underlying the formation of a pituitary abscess following transsphenoidal surgery. Debridement of the abscess through surgical approaches combined with antibiotic treatment has been found to yield positive outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

A probable case of Hand-Schueller-Christian's disease in an Egyptian mummy revealed by CT and MR investigation of a dry mummy.

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Cavka, Mislav; Petaros, Anja; Ivanac, Gordana; Aganović, Lejla; Janković, Ivor; Reiter, Gert; Speier, Peter; Nielles-Vallespin, Sonja; Brkljacić, Boris

2012-03-01

The challenging mission of paleopathologists is to be capable to diagnose a disease just on the basis of limited information gained by means of one or more paleodiagnostic techniques. In this study a radiologic, anthropologic and paleopathologic analysis of an ancient Egyptian mummy through X-rays, CT and MR was conducted. An Ancient Egyptian mummy ("Mistress of the house", Archeological Museum, Zagreb, Croatia) underwent digital radiography, computed tomography and magnetic resonance imaging employing 3-dimensional ultra-short-echo time (UTE) sequence, that allows to image ancient dry tissue. Morphological observations on the skull and pelvis, the stages of epiphyseal union and dental wear indicated that the remains are those of a young adult male. Multiple osseous lytic lesions were observed throughout the spine as well as on the frontal, parietal, and occipital bone, orbital wall and the sella turcica of the sphenoid. Considering the sex and age of the individual and the features of the lesions, the authors propose the diagnosis of Hand-Schueller-Christian's disease. This is the first study to have effectively used MR images in the differential diagnosis of a disease. It also confirmed the CT value in revealing central nervous system involvement just by detecting skeletal lesions. Although the mummy was previously dated to 3rd century B.C. based on the properties of the sarcophagi, the sex of the mummy suggests that it was most probably transferred into these sarcophagi in later times. The mummification techniques used and radiometric data (C14) dated it to 900-790. B.C.

A case of huge neurofibroma expanding extra- and intracranially through the enlarged jugular foramen

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Hanakita, Junya; Imataka, Kiyoharu; Handa, Hajime

1984-01-01

The surgical approach to the jugular foramen has been considered to be very difficult and troublesome, because of the location in which important structures, such as the internal jugular vein, internal carotid artery and lower cranial nerves, converge in the narrow deep space. A case of huge neurofibroma, which extended from the tentorium cerebelli through the dilated jugular foramen to the level of the vertebral body of C 3 was presented. A 12-year-old girl was admitted with complaints of visual disturbance and palsy of the V-XII cranial nerves of the left side. Plain skull film showed prominent widening of the cranial sutures and enlargement of the sella turcica. Horizontal CT scan with contrast showed symmetrical ventricular dilatation and a heterogeneously enhanced mass, which was situated mainly in the left CP angle. Coronal CT scan with contrast revealed a huge mass and enlarged jugular foramen, through which the tumor extended to the level of the vertebral body of C 3 . Occlusion of the sigmoid sinus and the internal jugular vein of the left side was noticed in the vertebral angiography. Two-stage approach, the first one for removal of the intracranial tumor and the second one for extracranial tumor, was performed for its huge tumor. Several authors have reported excellent surgical approaches for the tumors situated in the jugular foramen. By our approach, modifying Gardner's original one, a wide operative field was obtained to remove the tumor around the jugular foramen with success. Our approach for the jugular foramen was described with illustrations. (author)

Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck

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Samaan, N.A.; Vieto, R.; Schultz, P.N.; Maor, M.; Meoz, R.T.; Sampiere, V.A.; Cangir, A.; Ried, H.L.; Jesse, R.H. Jr.

1982-11-01

One hundred-ten patients who had nasopharyngeal cancer and paranasal sinus tumors and were free of the primary disease were studied one to 26 years following radiotherapy. There were 70 males and 40 females ranging in age from 4 to 75 years, with a mean age of 36.5 years. During therapy both the hypothalamus and the anterior pituitary gland were in the field of irradiation. The radiation dose to the hypothalamus and the anterior pituitary gland was estimated to be 400 to 7500 rad with a median dose of 5618 rad to the anterior pituitary gland and a median dose of 5000 rad to the hypothalamus. We found evidence of endocrine deficiencies in 91 of the 110 patients studied. Seventy-six patients showed evidence of one or more hypothalamic lesions and 43 patients showed evidence of primary pituitary deficiency. Forty of the 66 patients who received radiotherapy to the neck for treatment or prevention of lymph node metastasis showed evidence of primary hypothyroidism. The range of the dose to the thyroid area was 3000 to 8800 rad with a median of 5000 rad. One young adult woman who developed galactorrhea and amenorrhea 2 years following radiotherapy showed a high serum prolactin level, but had normal anterior pituitary function and sella turcica. She regained her menses and had a normal pregnancy and delivery following bromocriptine therapy. These results indicate that endocrine deficiencies after radiotherapy for tumors of the head and neck are common and should be detected early and treated. Long-term follow-up of these patients is indicated since complications may appear after the completion of radiotherapy.

Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck

International Nuclear Information System (INIS)

Samaan, N.A.; Vieto, R.; Schultz, P.N.; Maor, M.; Meoz, R.T.; Sampiere, V.A.; Cangir, A.; Ried, H.L.; Jesse, R.H. Jr.

1982-01-01

One hundred-ten patients who had nasopharyngeal cancer and paranasal sinus tumors and were free of the primary disease were studied one to 26 years following radiotherapy. There were 70 males and 40 females ranging in age from 4 to 75 years, with a mean age of 36.5 years. During therapy both the hypothalamus and the anterior pituitary gland were in the field of irradiation. The radiation dose to the hypothalamus and the anterior pituitary gland was estimated to be 400 to 7500 rad with a median dose of 5618 rad to the anterior pituitary gland and a median dose of 5000 rad to the hypothalamus. We found evidence of endocrine deficiencies in 91 of the 110 patients studied. Seventy-six patients showed evidence of one or more hypothalamic lesions and 43 patients showed evidence of primary pituitary deficiency. Forty of the 66 patients who received radiotherapy to the neck for treatment or prevention of lymph node metastasis showed evidence of primary hypothyroidism. The range of the dose to the thyroid area was 3000 to 8800 rad with a median of 5000 rad. One young adult woman who developed galactorrhea and amenorrhea 2 years following radiotherapy showed a high serum prolactin level, but had normal anterior pituitary function and sella turcica. She regained her menses and had a normal pregnancy and delivery following bromocriptine therapy. These results indicate that endocrine deficiencies after radiotherapy for tumors of the head and neck are common and should be detected early and treated. Long-term follow-up of these patients is indicated since complications may appear after the completion of radiotherapy

Preoperative Assessment of Craniopharyngioma Adherence: Magnetic Resonance Imaging Findings Correlated with the Severity of Tumor Attachment to the Hypothalamus.

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Prieto, Ruth; Pascual, José M; Rosdolsky, Maria; Barrios, Laura

2018-02-01

Craniopharyngioma (CP) adherence represents a heterogeneous pathologic feature that critically influences the potentially safe and radical resection. The aim of this study was to define the magnetic resonance imaging (MRI) predictors of CP adherence severity. This study retrospectively investigated a cohort of 200 surgically treated CPs with their corresponding preoperative conventional MRI scans. MRI findings related to the distortions of anatomic structures along the sella turcica-third ventricle axis caused by CPs, in addition to the tumor's shape and calcifications, were analyzed and correlated with the definitive type of CP adherence observed during the surgical procedures. CP adherence is defined by 3 components, as follows: 1) the specific structures attached to the tumor, 2) the adhesion's extent, and 3) its strength. Combination of these 3 components determines 5 hierarchical levels of adherence severity with gradually increasing surgical risk of hypothalamic injury. Multivariate analysis identified 4 radiologic variables that allowed a correct overall prediction of the levels of CP adherence severity in 81.5% of cases: 1) the position of the hypothalamus in relation to the tumor-the most discriminant factor; 2) the type of pituitary stalk distortion; 3) the tumor shape; and 4) the presence of calcifications. A binary logistic regression model including the first 3 radiologic variables correctly identified the CPs showing the highest level of adherence severity (severe/critical) in almost 90% of cases. A position of the hypothalamus around the middle portion of the tumor, an amputated or infiltrated appearance of the pituitary stalk, and the elliptical shape of the tumor are reliable predictors of strong and extensive CP adhesions to the hypothalamus. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors influencing superimposition error of 3D cephalometric landmarks by plane orientation method using 4 reference points: 4 point superimposition error regression model.

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Hwang, Jae Joon; Kim, Kee-Deog; Park, Hyok; Park, Chang Seo; Jeong, Ho-Gul

2014-01-01

Superimposition has been used as a method to evaluate the changes of orthodontic or orthopedic treatment in the dental field. With the introduction of cone beam CT (CBCT), evaluating 3 dimensional changes after treatment became possible by superimposition. 4 point plane orientation is one of the simplest ways to achieve superimposition of 3 dimensional images. To find factors influencing superimposition error of cephalometric landmarks by 4 point plane orientation method and to evaluate the reproducibility of cephalometric landmarks for analyzing superimposition error, 20 patients were analyzed who had normal skeletal and occlusal relationship and took CBCT for diagnosis of temporomandibular disorder. The nasion, sella turcica, basion and midpoint between the left and the right most posterior point of the lesser wing of sphenoidal bone were used to define a three-dimensional (3D) anatomical reference co-ordinate system. Another 15 reference cephalometric points were also determined three times in the same image. Reorientation error of each landmark could be explained substantially (23%) by linear regression model, which consists of 3 factors describing position of each landmark towards reference axes and locating error. 4 point plane orientation system may produce an amount of reorientation error that may vary according to the perpendicular distance between the landmark and the x-axis; the reorientation error also increases as the locating error and shift of reference axes viewed from each landmark increases. Therefore, in order to reduce the reorientation error, accuracy of all landmarks including the reference points is important. Construction of the regression model using reference points of greater precision is required for the clinical application of this model.

Consideraciones sobre el diagnóstico por imágenes de las masas selares Reflection on imaging diagnosis of sellar masses

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José Arturo Hernández Yero

2005-12-01

Full Text Available Con el propósito de hacer un llamado de atención sobre una temática de importancia y tomando en consideración que con los avances en la imagenología moderna se aportan elementos distintivos y de gran utilidad en el diagnóstico por imágenes de un grupo de masas en la región de la silla turca, se hacen determinadas valoraciones al respecto, con precisión de algunas de las características de las principales masas selares y su apariencia en la resonancia magnética nuclear. Se destacan detalles en cuanto a la intensidad de la señal en los adenomas pituitarios, craneofaringiomas, quistes de la bolsa de Rathke, hiperplasia hipofisaria y el denominado síndrome de la silla turca vacía, entre otras causas de cambios anatómicos en la región selar. Se concluye que la imagen por resonancia magnética nuclear sería el método idóneo para un mejor diagnóstico de las masas selares aunque, en ausencia de esta, la tomografía contrastada puede resultar de utilidad si se realiza con cortes menores de 2 mm. Se resalta la importancia de integrar un equipo multidisciplinario entre clínicos, endocrinólogos, imagenólogos, neurocirujanos y anatomopatólogos, para obtener diagnósticos más precisos y resultados terapéuticos adecuados.Some reflections were made on imaging diagnosis of sellar masses, specifying some characteristics of the main sellar masses and their appearance in magnetic resonance imaging. The purpose was to call the attention on this important issue on the basis that modern imaging advances offer very useful distinctive elements in the diagnosis of a group of masses located in the sella turcica region. The paper underlined details of signal intensity in pituitary adenomas, craniopharyngiomas, Rathke´s pouch cysts, hypophysial hyperplasia and the so-called empty sella syndrome, among other causes of anatomical changes in sellar region. It was concluded that magnetic resonance imaging would be the ideal method for a better

Lycopene and beta-carotene induce growth inhibition and proapoptotic effects on ACTH-secreting pituitary adenoma cells.

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Natália F Haddad

Full Text Available Pituitary adenomas comprise approximately 10-15% of intracranial tumors and result in morbidity associated with altered hormonal patterns, therapy and compression of adjacent sella turcica structures. The use of functional foods containing carotenoids contributes to reduce the risk of chronic diseases such as cancer and vascular disorders. In this study, we evaluated the influence of different concentrations of beta-carotene and lycopene on cell viability, colony formation, cell cycle, apoptosis, hormone secretion, intercellular communication and expression of connexin 43, Skp2 and p27(kip1 in ACTH-secreting pituitary adenoma cells, the AtT20 cells, incubated for 48 and 96 h with these carotenoids. We observed a decrease in cell viability caused by the lycopene and beta-carotene treatments; in these conditions, the clonogenic ability of the cells was also significantly decreased. Cell cycle analysis revealed that beta-carotene induced an increase of the cells in S and G2/M phases; furthermore, lycopene increased the proportion of these cells in G0/G1 while decreasing the S and G2/M phases. Also, carotenoids induced apoptosis after 96 h. Lycopene and beta-carotene decreased the secretion of ACTH in AtT20 cells in a dose-dependent manner. Carotenoids blocked the gap junction intercellular communication. In addition, the treatments increased the expression of phosphorylated connexin43. Finally, we also demonstrate decreased expression of S-phase kinase-associated protein 2 (Skp2 and increased expression of p27(kip1 in carotenoid-treated cells. These results show that lycopene and beta-carotene were able to negatively modulate events related to the malignant phenotype of AtT-20 cells, through a mechanism that could involve changes in the expression of connexin 43, Skp2 and p27(kip1; and suggest that these compounds might provide a novel pharmacological approach to the treatment of Cushing's disease.

Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma.

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Peng, Zesheng; Tian, Daofeng; Wang, Hongliu; Kong, Derek Kai; Zhang, Shenqi; Liu, Baohui; Deng, Gang; Xu, Zhou; Wu, Liquan; Ji, Baowei; Wang, Long; Cai, Qiang; Li, Mingchang; Wang, Junmin; Zhang, Aimin; Chen, Qianxue

2015-01-01

Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients.

A Case of Acromegaly in which a Pituitary Gland Tumor was Reduced Significantly by Administering Octreotide Long Acting Release (LAR) and Could Be Removed Surgically.

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Arao, Tadashi; Okada, Yosuke; Uemura, Fumi; Nishizawa, Shigeru; Tanaka, Yoshiya

A 54-year-old woman was admitted to our hospital for detailed examination of acromegaly because she noticed bilateral hand and finger swelling at the age of 43 and plantar thickening, facial changes and unclear articulation at the age of 49. She had prominent brow ridges, mandibular protrusion, and enlargement of the hands, feet, nasal wings, lips and tongue. Her growth hormone (GH) level was 39.8 ng/ml, insulin-like growth factor-1 (IGF-1) level was 717 ng/ml, GH level was not suppressed (22.9 ng/ml) during a 75-g oral glucose tolerance test (OGTT). Radiography showed cauliflower-like enlargement of the distal phalanx of the fingers, thickening/enlargement of the plantar soft tissues, and increased antero-posterior diameter of the sella turcica. Magnetic resonance imaging showed a mass (21×17 mm) growing towards the right suprasellar region and invading the cavernous sinus. She was diagnosed with acromegaly based on the characteristic physical findings, GH excess, high IGF-1, lack of GH suppression during the 75-g OGTT, and the presence of a pituitary tumor. She was started on octreotide long acting release (Oct-LAR) 20 mg/4w for tumor shrinkage. After three doses, her GH and IGF-1 levels decreased to 2.19 ng/ml (1.69 during the 75-g OGTT) and 205 ng/ml, respectively, meeting cure criteria for acromegaly. In this case, a decrease in GH and IGF-1 levels, tumor shrinkage, and resolution of cavernous sinus invasion allowed the patient to undergo surgery with curative intent (the first-line treatment for acromegaly) without postoperative complications. Thus, preoperative Oct-LAR administration has the potential to improve treatment outcomes of acromegaly.

High intensity signal of the posterior pituitary. A study with horizontal direction of frequency-encoding and fat suppression MR techniques

International Nuclear Information System (INIS)

Arslan, A.

1999-01-01

Purpose: To evaluate the consistency of fat in the high intensity signals of the normal neurohypophysis and to differentiate the high signal of posterior pituitary from that of dorsum sella. Sagittal SE T1-weighted images with frequency encoding in the horizontal direction were used in order to differentiate the high signal of posterior pituitary and dorsum sella by the vertically-oriented chemical shift artifact. Material and methods: The sellae of 46 normal volunteers were imaged with a commercially available fat suppression technique and SE sequences with frequency encoding in vertical (25 cases) and horizontal (21 cases) axes. Results: The high signal intensity was absent in 9% of the normal volunteers with no predilection to any specific age group. None of the cases with posterior pituitary high intensity signals showed suppression of the signal with fat suppression technique. A fat suppression technique was helpful in documenting the hyperintensity in 7% of normal volunteers. Nineteen of the 21 (90%) cases with high signal intensity were detected by routine SE T1-weighted images, whereas 18 of the 19 (95%) cases were detected by imaging with frequency encoding in the horizontal direction. Conclusion: The high signal does not indicate the presence of fat. Fat suppression technique and a horizontal direction of frequency encoding help in differentiating the high signal of the neurohypophysis from that of dorsum sella. (orig.)

Pituitary Macroprolactinoma with Mildly Elevated Serum Prolactin: Hook Effect

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Mahnaz Pejman-Sani

2018-04-01

Full Text Available A 45-year-old man was admitted in our department with complaints of severe headache for over 6 months period. He also suffered from several problems such as visual field defect, decreased energy and libido, body hair loss, cold intolerance, decreased appetite and dry skin. On physical examination, he was afebrile: BP (blood pressure: 110/70 mm/Hg, PR (pulse rate :65 beat/min, BMI (body mass index: 24. He had no terminal hair on face or chest and subcutaneous adipose tissue mass had been decreased substantially. Laboratory tests revealed; Hb: 12 g/dL (N: 14–17 g/dL, Total testosterone: 1.2 ng/mL (N:–-10 ng/mL, Luteinizing hormone (LH:3.3MIU/mL (N:1–8 MIU/mL, Follicle Stimulating hormone (FSH:1.3 MIU/mL (N:1–7 MIU/mL, T4:3.4 micg/dL (N:4–12 micg/dL, TSH:0.6 MIU/mL (N:0.5–5 MIU/mL, Prolactin:100 ng/mL (2–24 ng/mL, serum cortisol:6 MIU/mL (N:4–21 MIU/mL, IGF1:162 ng/mL (50–245. Pituitary MRI showed macroadenoma (29*16*14 mm in left side of sella turcica which bulged to suprasellar cistern with pressure effect on left optic nerve (Figure 1, 2. Visual field examination revealed mild temporal hemianopia. These findings are consistent with macroadenoma and mild prolactin elevation. We also observed a discrepancy between pituitary tumor size and prolactin level. The correct estimate of serum prolactin was obtained after serial dilutional measurement. Serum prolactin after dilution was 6470 ng/mL. With these findings pituitary macroadenoma was diagnosed and treatment with cabergoline (dopamine agonist 0.5 mg/week was started. After one month follow-up he had no symptoms, visual field defect was improved and pituitary MRI showed significant shrinkage of tumor.

Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up Fístula liquórica como manifestação inicial de macroadenoma hipofisário: relato de caso com 4 anos de seguimento

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Ricardo Alexandre Hanel

2001-06-01

Full Text Available We report the case of a young woman who presented with cerebrospinal fluid (CSF rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.Relatamos o caso de uma paciente que se apresentou com fístula liquórica devido a macroadenoma de hipófise sem diagnóstico e/ou tratamento prévio. O tumor estendia-se além dos limites da sela túrcica, causando erosão óssea. A paciente inicialmente recusou tratamento cirúrgico e foi então tratada com bromocriptina e radioterapia convencional. O fluxo de liquor da fístula não diminuiu e desta feita a paciente concordou com a realização da cirurgia. Realizou-se acesso transesfenoidal com remoção da massa tumoral do seio esfenoidal e selar. A origem da fístula foi reparada com enxerto autólago de fascia lata. Drenagem liquórica lombar foi utilizada por 5 dias. Atualmente, após 4 anos de seguimento, a paciente se apresenta com níveis normais de prolactina e sem sinais de fístula liquórica. Discutimos o mecanismo fisiopatológico desta rara apresentação dos tumores hipofisários bem como seu manejo e complicações.

Lycopene and Beta-Carotene Induce Growth Inhibition and Proapoptotic Effects on ACTH-Secreting Pituitary Adenoma Cells

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Leite de Oliveira, Felipe; Soares, Nathália; de Mattos, Rômulo Medina; Hecht, Fábio; Dezonne, Rômulo Sperduto; Vairo, Leandro; Goldenberg, Regina Coeli dos Santos; Gomes, Flávia Carvalho Alcântara; de Carvalho, Denise Pires; Gadelha, Mônica R.; Nasciutti, Luiz Eurico; Miranda-Alves, Leandro

2013-01-01

Pituitary adenomas comprise approximately 10–15% of intracranial tumors and result in morbidity associated with altered hormonal patterns, therapy and compression of adjacent sella turcica structures. The use of functional foods containing carotenoids contributes to reduce the risk of chronic diseases such as cancer and vascular disorders. In this study, we evaluated the influence of different concentrations of beta-carotene and lycopene on cell viability, colony formation, cell cycle, apoptosis, hormone secretion, intercellular communication and expression of connexin 43, Skp2 and p27kip1 in ACTH-secreting pituitary adenoma cells, the AtT20 cells, incubated for 48 and 96 h with these carotenoids. We observed a decrease in cell viability caused by the lycopene and beta-carotene treatments; in these conditions, the clonogenic ability of the cells was also significantly decreased. Cell cycle analysis revealed that beta-carotene induced an increase of the cells in S and G2/M phases; furthermore, lycopene increased the proportion of these cells in G0/G1 while decreasing the S and G2/M phases. Also, carotenoids induced apoptosis after 96 h. Lycopene and beta-carotene decreased the secretion of ACTH in AtT20 cells in a dose-dependent manner. Carotenoids blocked the gap junction intercellular communication. In addition, the treatments increased the expression of phosphorylated connexin43. Finally, we also demonstrate decreased expression of S-phase kinase-associated protein 2 (Skp2) and increased expression of p27kip1 in carotenoid-treated cells. These results show that lycopene and beta-carotene were able to negatively modulate events related to the malignant phenotype of AtT-20 cells, through a mechanism that could involve changes in the expression of connexin 43, Skp2 and p27kip1; and suggest that these compounds might provide a novel pharmacological approach to the treatment of Cushing’s disease. PMID:23667519

Thyroid Homoeostasis and Reproductive Hormonal Disorders in Women

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А.А. Yunusov

2014-11-01

Full Text Available Objective of the study — to investigate the influence of hypo- and hyperthyroidism on the state of reproductive function for women and to estimate efficiency of treatment. Material and Methods. 156 women of reproductive age are examined concerning inflammatory gynaecological and endocrine disorders. Complex of laboratory and clinical investigations included: anamnesis, examination; unified clinical and biochemical methods of research; studying research hormones in blood plasma (thyroid stimulating hormone, prolactine, Т3, Т4, fТ4, antibodies to thyroglobulin, thyroid peroxidase; luteinizing hormone, follicle-stimulating hormone (FSH, estradiol, progesteron, testosteron; ultrasonic examination of thyroid gland, mammary gland, pelvic organs; radiography of sella turcica; fine needle biopsy of the thyroid. Results. The comparative analysis of different pathologies of reproductive function in both clinical groups showed, that infertility, both primary and secondary, prevailed in the group with hypothyroidism — 66 vs 33.3 % in the group of women with hyperthyroidism. In the first clinical group, signs of menstrual disorders (68.2 %, galactorrhea (63.6 %, breast pathology (55 % also prevailed, while in the second group these indexes were 38.8, 22.2 and 33.3 %, respectively. In the structure of menstrual disorders, oligomenorrhea prevailed in both clinical groups — 47 and 57 %. Most women (76.9 % had I degree of galactorrhea and bilateral galactorrhea (80.7 %. Cervical pathology was detected 45 % of women, with predominance of pseudoerosion (55.5 %, and in 12.5% — hysteromyoma. Chronic salpingo-oophoritis was diagnosed in 47.5 % of patients, cystic ovaries — in 10 % of women of clinical group. Conclusions. Thyroid pathology in women of reproductive age is characterized by autoimmune thyroiditis (24.3 %, diffuse toxic goiter (10.8 % and nodular goiter (16.2 %. Women with thyroid hormone deficit have a decline of gonadotropic pituitary

A cephalometric analysis of the cranial base and frontal part of the face in patients with mandibular prognathism

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Čutović Tatjana

2014-01-01

Full Text Available Bacground/Aim. The literature suggests different views on the correlation between the cranial base morphology and size and saggital intermaxillary relationships. The aim of this study was to investigate the cranial base morphology, including the frontal facial part in patients with mandibular prognathism, to clarify a certain ambiguities, in opposing viewspoints in the literature. Methods. Cephalometric radiographies of 60 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, with no previous orthodontic treatment. On the basis of dental and sceletal relations of jaws and teeth, the patients were divided into two groups: the group P (patients with mandibular prognathism and the group E (the control group or eugnathic patients. A total of 15 cephalometric parametres related to the cranial base, frontal part of the face and sagittal intermaxillary relationships were measured and analyzed. Results. The results show that cranial base dimensions and the angle do not play a significant role in the development of mandibular prognathism. Interrelationship analysis indicated a statistically significant negative correlation between the cranial base angle (NSAr and the angles of maxillary (SNA and mandibular (SNB prognathism, as well as a positive correlation between the angle of inclination of the ramus to the cranial base (GoArNS and the angle of sagittal intermaxillary relationships (ANB. Sella turcica dimensions, its width and depth, as well as the nasal bone length were significantly increased in the patients with mandibular prognathism, while the other analyzed frontal part dimensions of the face were not changed by the malocclusion in comparison with the eugnathic patients. Conclusion. This study shows that the impact of the cranial base and the frontal part of the face on the development of profile in patients with mandibular prognathism is much smaller, but

Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT)

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Gueldner, Christian; Pistorius, Sarah M.; Diogo, Isabell; Sesterhenn, Andreas; Werner, Jochen A. (Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg (Germany)), Email: gueldner@staff.uni-marburg.de; Bien, Siegfried (Department of Neuroradiology, UKGM, Marburg (Germany))

2012-03-15

Background. The sphenoid sinus is a frequent target of paranasal sinus surgery. Because of the high risk of injuring the surrounding structures (e.g. internal carotid artery, optical nerve) a preoperative imaging is absolutely necessary. Purpose. To analyze the possibilities of cone-beam computed tomography (CBCT), which is especially quite a new technique in ENT, in the evaluation of the sphenoid sinus, its surrounding structures, and the corresponding anatomical variations. Material and Methods. This was a retrospective, single-centre study of 580 patients (1160 sides = cases). The Accu-I-Tomo-F17 was used. Pneumatization of sphenoid sinus, course of internal artery, course of optical nerve, and dehiscence of the bony canals were evaluated. Results. In the case of pneumatization a type I (completely missing or minimal sphenoid sinus) was found in two patients (0.3%), type II (posterior wall of sphenoid sinus is in front of the anterior wall of the sella) in 38 patients (6.6%), type III (posterior wall is between anterior and posterior wall of sella) in 332 patients (57,2%), type IVa (posterior wall is behind the posterior wall of sella without air dorsal the sella) in 104 patients (17.9%), and type IVb (similar to type IVa but with air dorsal the sella) in 104 patients (17.9%). In 1025 cases (89.5%) a smooth course of the internal carotid artery was found whereas a free course could be detected in 120 cases (10.5%). Defects of the bony canal of the optical nerve were found in 16.7% and of the internal carotid artery in 2.7% of the cases. The optical nerve showed a free course through the sphenoid in 151 cases (13.7%) and a smooth course in 1007 cases (87.0%). Conclusion. CBCT could evaluate all relevant anatomic structures and answer the questions of different anatomical variants. A modified classification of the pneumatization of the sphenoid sinus could be described. Frequencies of anatomical variations are in accordance with the current literature of CT

Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT)

International Nuclear Information System (INIS)

Gueldner, Christian; Pistorius, Sarah M.; Diogo, Isabell; Sesterhenn, Andreas; Werner, Jochen A.; Bien, Siegfried

2012-01-01

Background. The sphenoid sinus is a frequent target of paranasal sinus surgery. Because of the high risk of injuring the surrounding structures (e.g. internal carotid artery, optical nerve) a preoperative imaging is absolutely necessary. Purpose. To analyze the possibilities of cone-beam computed tomography (CBCT), which is especially quite a new technique in ENT, in the evaluation of the sphenoid sinus, its surrounding structures, and the corresponding anatomical variations. Material and Methods. This was a retrospective, single-centre study of 580 patients (1160 sides = cases). The Accu-I-Tomo-F17 was used. Pneumatization of sphenoid sinus, course of internal artery, course of optical nerve, and dehiscence of the bony canals were evaluated. Results. In the case of pneumatization a type I (completely missing or minimal sphenoid sinus) was found in two patients (0.3%), type II (posterior wall of sphenoid sinus is in front of the anterior wall of the sella) in 38 patients (6.6%), type III (posterior wall is between anterior and posterior wall of sella) in 332 patients (57,2%), type IVa (posterior wall is behind the posterior wall of sella without air dorsal the sella) in 104 patients (17.9%), and type IVb (similar to type IVa but with air dorsal the sella) in 104 patients (17.9%). In 1025 cases (89.5%) a smooth course of the internal carotid artery was found whereas a free course could be detected in 120 cases (10.5%). Defects of the bony canal of the optical nerve were found in 16.7% and of the internal carotid artery in 2.7% of the cases. The optical nerve showed a free course through the sphenoid in 151 cases (13.7%) and a smooth course in 1007 cases (87.0%). Conclusion. CBCT could evaluate all relevant anatomic structures and answer the questions of different anatomical variants. A modified classification of the pneumatization of the sphenoid sinus could be described. Frequencies of anatomical variations are in accordance with the current literature of CT

Maxillary Distraction Osteogenesis Using a Rigid External Distractor: Which Clinical Factors Are Related With Relapse?

Science.gov (United States)

Kim, Jeenam; Uhm, Ki-Il; Shin, Donghyeok; Lee, Jina; Choi, Hyungon

2015-06-01

Maxillary distraction osteogenesis is a reliable treatment for cleft lip and palate with midfacial retrusion. The purpose of this study was to evaluate the results of long-term follow-up in patients with cleft lip and palate after maxillary distraction osteogenesis and to find clinical factors related to relapse. From February 2002 to June 2008, 21 patients with severe class III malocclusion were treated at our hospital. We performed distraction osteotomy with a rigid external distractor device. The distraction length was more than 15 mm in all patients. Preoperative and postoperative lateral cephalometric radiographs were used for analysis. The sella-nasion-subnasale, sella-nasion-supramentale, and point-A-point-B-nasion (sella-nasion-subnasale-sella-nasion-supramentale) angles were recorded. The timelines for follow-up were preoperatively, after distraction, after consolidation, at 3 years, and once fully grown (5- to 8-year follow-ups). A comparative analysis of clinical factors was performed for the relapsing and nonrelapsing groups. Of the 21 patients, 14 had relapsed. The mean age in the relapsing group was 9.1 years (7 boys and 7 girls) with 9 patients with unilateral cleft palate and 5 c bilateral cleft palate. The mean age in the nonrelapsing group was 11.7 years (4 boys and 3 girls) with 5 patients with unilateral cleft palate and 2 patients with bilateral cleft palate. Despite greater anterior overcorrection, relapse occurred owing to scar tissue retraction and mandibular compensatory hypertrophy. The results suggest that the younger the patient, the more likely relapse will occur.

Transsphenoidal hypophysectomy: postsurgical CT findings

International Nuclear Information System (INIS)

Dolinskas, C.A.; Simeone, F.A.

1985-01-01

Transsphenoidal surgery produces changes in the paranasal sinuses and sella that should be familiar to radiologists in view of frequency of this type of surgery. Some of these changes, such as soft-tissue-density debris in the sinuses, are transient. Fat and other packing material identifiable in the sinuses and sella after surgery is permanent. The procedure is associated with a variety of complications that are readily detectable by computed tomography (CT). These include bleeding, compression of parasellar structures by packing material, cerebrospinal fluid leaks, and pneumocephalus. After a transsphenoidal procedure, with or without follow-up radiation therapy, residual enhancing intrasellar and parasellar lesions may still be identified

CT of sella after pituitary surgery

International Nuclear Information System (INIS)

Frank, W.; Imhof, H.; Schratter, M.; Knosp, E.

1986-01-01

A CT control scan of 32 patients after transsphenoidal resection of a pituitary tumour revealed sellar contents of different density and varying extent. Additional criteria were used to differentiate the intrasellar structures (size, extent, shape, structure, contrast enhancement, bone changes). CT made the definite diagnosis in 6 patients with pituitary tumour recurrence. Hormonal measurements were superior to CT in identifying recurrent tumours in another 3 patients. It is concluded that hormonal methods should be used in evaluating patients after surgery of a hormone-producing tumour. However, CT is the most useful method in detecting tumour recurrence in patients with non-functioning adenomas, and, if an adequate technique is used (coronal scanning, iv-contrast), even clinical asymptomatic tumours can be identified. (orig.) [de

Rilievi in sella a un quad

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Fulvio Bernardini

2013-12-01

Full Text Available Renewable energy—including biomass, geo- thermal, hydroelectric,wind and solar—is big business in Italy. Solar farms able toproduce 1 MW or more of nominal power are considered “large.”Before installing such a PV plant, an acc urate topographical surveyof the ground is required. Giuseppe Greco is known in Italyas an expert in surv eying areas that are extensive and difficult toacc ess. This is because he works with the help of a quad all-terr ainvehicle (AT V, a Segway personal transporter and a personal electricrobotic cart for moving his equipment.

Geometry of third ventricle: radiological measurements supported by neuroendoscopic observations

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Novak, Z.; Chrastina, J. [Neurosurgical Dept., Faculty Hospital, St Anns, MF MU, Brno (Czech Republic); Krupa, P.; Feitova, V. [Dept. of Imaging Techniques, Faculty Hospital, St Anns, MF MU, Brno (Czech Republic); Riha, I. [Neurosurgical Dept., Faculty Hospital, St Anns, MF MU, Brno (Czech Republic); Inst. of Biomedical Engineering, FEEC BUT, Brno (Czech Republic)

2007-06-15

The aim od the study was to analyse the changes of third ventricular geometry caused by hydrocephalus. The data were obtained from planning studies for neuroendoscopic surgeries using stereotactic software Praezis Plus. Parameters CA-CP (intercommisural distance-corresponding to third ventricular length), IMD (intermammillary distance-third ventricular width), H (third ventricular height), BA-DS distance (distance between basilar artery bifurcation and dorsum sellae) and MB-BA distance were studied. After statistical analysis table of normal values is proposed for all the defined parameters. Statistically significant changes were found in all the measured parameters (CA-CP, IMD, H, MB-BA) in hydrocephalic patients except the distance between basilar artery and dorsum sellae, defining safe area for endoscopic third ventriculostomy. (orig.)

Magnetic resonance imaging of hypothalamus hypophysis axis lesions

International Nuclear Information System (INIS)

Shiina, Takeki; Uno, Kimiichi; Arimizu, Noboru; Yoshida, Sho; Yamada, Kenichi.

1990-01-01

Magnetic resonance imaging (MRI) using a 0.5T superconductive machine was performed to the thirty three cases with a variety of the sellar and parasellar tumors and with dysfunction of the hypothalamus-hypophysis axis. Posterior pituitary bright spot (PBS) on T1 weighted image was evaluated with the pituitary hormonal function. These cases were 12 cases of post-treated tumors including pituitary adenoma (9 patients), suprasellar germinoma (2 patients) and craniopharyngioma (one patient), and non-tumorous conditions including 15 cases of central diabetes insipidus (DI), Syndrome of inappropriate secretion of ADH (SIADH) (one patient), Sheehan's syndrome (3 patients) and anorexia nervosa (2 patients). Pituitary bright spot was not seen in all 19 cases with overt DI. On the other hand, PBS was not seen in 9 cases without overt DI. Three cases of these 9 cases showing Sheehan's syndrome with insufficient antidiuretic hormone (ADH) secretion was considered as the state of subclinical DI. Posterior bright spot was not seen in all 13 cases of empty sella including partial empty sella. The results suggested that disappearance of PBS represents abnormality or loss of posterior pituitary function and also it was considered to be closely related to the empty sella. (author)

Magnetic resonance imaging of hypothalamus hypophysis axis lesions; Relationship between posterior pituitary function and posterior bright spot

Energy Technology Data Exchange (ETDEWEB)

Shiina, Takeki; Uno, Kimiichi; Arimizu, Noboru; Yoshida, Sho (Chiba Univ. (Japan). School of Medicine); Yamada, Kenichi

1990-04-01

Magnetic resonance imaging (MRI) using a 0.5T superconductive machine was performed to the thirty three cases with a variety of the sellar and parasellar tumors and with dysfunction of the hypothalamus-hypophysis axis. Posterior pituitary bright spot (PBS) on T1 weighted image was evaluated with the pituitary hormonal function. These cases were 12 cases of post-treated tumors including pituitary adenoma (9 patients), suprasellar germinoma (2 patients) and craniopharyngioma (one patient), and non-tumorous conditions including 15 cases of central diabetes insipidus (DI), Syndrome of inappropriate secretion of ADH (SIADH) (one patient), Sheehan's syndrome (3 patients) and anorexia nervosa (2 patients). Pituitary bright spot was not seen in all 19 cases with overt DI. On the other hand, PBS was not seen in 9 cases without overt DI. Three cases of these 9 cases showing Sheehan's syndrome with insufficient antidiuretic hormone (ADH) secretion was considered as the state of subclinical DI. Posterior bright spot was not seen in all 13 cases of empty sella including partial empty sella. The results suggested that disappearance of PBS represents abnormality or loss of posterior pituitary function and also it was considered to be closely related to the empty sella. (author).

Transstadial Transmission of Borrelia turcica in Hyalomma aegyptium Ticks

Czech Academy of Sciences Publication Activity Database

Kalmár, Z.; Cozma, V.; Sprong, H.; Jahfari, S.; D’Amico, G.; Mărcutan, D.I.; Ionică, A.M.; Magdaş, C.; Modrý, David; Mihalca, A. D.

2015-01-01

Roč. 10, č. 2 (2015), e0115520 E-ISSN 1932-6203 Institutional support: RVO:60077344 Keywords : Borne relapsing fever * Lyme disease * imported reptiles Subject RIV: GJ - Animal Vermins ; Diseases, Veterinary Medicine Impact factor: 3.057, year: 2015

Empty Sella Syndrome complicating meningitis | Ogunrin | Nigerian ...

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A.O. Ogunrin, V. Ajiduah, R. Onyemekeihia, M.T. Shokunbi. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners ...

Introduction: surgical management of skull base meningiomas.

Science.gov (United States)

Zada, Gabriel; Başkaya, Mustafa K; Shah, Mitesh V

2017-10-01

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency. In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors

Effectiveness of the cervical vertebral maturation method to predict postpeak circumpubertal growth of craniofacial structures.

Science.gov (United States)

Fudalej, Piotr; Bollen, Anne-Marie

2010-01-01

Our aim was to assess effectiveness of the cervical vertebral maturation (CVM) method to predict circumpubertal craniofacial growth in the postpeak period. The CVM stage was determined in 176 subjects (51 adolescent boys and 125 adolescent girls) on cephalograms taken at the end of treatment (T2; mean ages, 15.75 years [boys] and 15.23 years [girls]) in subjects from the postretention database at the University of Washington in Seattle. Craniofacial growth was evaluated from the following measurements on cephalograms at T2 and end of follow-up (T3) (mean ages, 29.01 years [men] and 28.08 years [women]): condylion to gnathion, condylion to gonion, gonion to gnathion, sella to gnathion, nasion to menton, anterior nasal spine to menton, and sella to gonion. The change of each variable from T2 to T3 was assessed with paired t tests. Parametric (t tests or analysis of variance [ANOVA]) or nonparametric (Mann-Whitney or Kruskal-Wallis) tests were used to detect intergroup differences. One hundred eight subjects (35 boys, 73 girls) demonstrated CVM stage 3, 56 (16 boys, 40 girls) were in CVM stage 4, and 12 (all girls) were in CVM stage 5 at T2. Intrasex comparisons showed that boys in CVM stages 3 and 4 could be differentiated regarding changes of all variables. In the girls, only those in CVM stages 3 and 4 could be differentiated based on the amount of changes of 2 measurements: condylion to gonion and sella to gonion. Intersex comparisons showed that boys in CVM stage 3 had significantly more changes than girls (P <0.01). Boys in CVM stage 4 showed significant differences compared with girls in CVM stage 4 for only 2 variables (sella to gonion and condylion to gonion; P <0.001 and P = 0.012, respectively). The CVM method was modestly effective in determining the amount of postpeak circumpubertal craniofacial growth. Copyright 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

CT follow-up after radiation therapy for pituitary adenomas

International Nuclear Information System (INIS)

Rush, S.C.; Newall, J.

1988-01-01

Between 1973 and 1985, 105 patients received radiation therapy as all or part of their treatment for pituitary tumor at the New York University Medical Center. Of these, 48 patients underwent computed tomography (CT) at a minimum of 2 years following treatment, with detailed reports available for analysis of tumor regression. There were 28 men with a median age of 46 years (range, 18-71 years) and 20 women with a median age of 53 years (range, 28-80 years). Tumors were classified as secretory in 23 patients, nonsecretory in 21, and undetermined in four. Sixteen patients were treated with radiation therapy alone, 23 patients with surgery and radiation therapy, and the other with bromocriptine and radiation therapy, with or without surgery. With a median follow-up of 5 years (range, 2-14 years), 16 patients developed an empty sella, 25 patients had residual sellar mass, and seven patients had persistent extrasellar components or no change in their intrasellar mass. Among patients who did not have hypopituitarism at the inception of radiation therapy, five of 13 with empty sellas and 12 of 22 with residual mass subsequently required therapy. The authors conclude that residual mass is commonly found in long-term follow-up after radiation therapy, that isolated imaging studies revealing such findings after treatment in no way herald a diagnosis of recurrence, and that hypopituitarism following pituitary radiation therapy does not correlate with the ablation or persistence of tissue within the sella

Syndroom van Cushing. II. Nieuwe behandelingen

NARCIS (Netherlands)

van Aken, M. O.; Feelders, R. A.; van der Lely, A. J.; Romijn, J. A.; Lamberts, S. W. J.; de Herder, W. W.

2006-01-01

Several new therapeutic options both medicinal and surgical, have emerged for the treatment of Cushing's syndrome. In Cushing's disease caused by an adrenocorticotropin (ACTH) secreting pituitary adenoma, the introduction ofendoscopic pituitary surgery offers better visualization of the sella than

Variability in sphenoid sinus pneumatization and its impact upon reduction of complications following sellar region surgeries

Directory of Open Access Journals (Sweden)

Tarek H. ELKammash

2014-09-01

Conclusion: Pre-intervention assessment of sphenoid sinus pneumatization is mandatory in approaching the sella and skull base structures either via the nose or open skull base surgery to avoid injury of the nearby structures and reduce the possibility of CSF leakage.

Evaluation of adenohypophyseal reserve in patients carrier of hypophyseal adenoma treated by trans-sphenoidal surgery

International Nuclear Information System (INIS)

Drubscky, A.T.

1980-01-01

Fifteen patients carrier hypophyseal adenomas, with ages varying between 16 to 53 years were studied. The patients presented sella changes to the conventional plane radiographies and were submited a surgery treatment, with acess to hypophysis by the trans-sphenoidal way. (author)

Distraction rate and latency: factors in the outcome of paediatric maxillary distraction.

Science.gov (United States)

Higuera, Stephen; Cole, Patrick; Stephenson, J B; Hollier, Larry

2009-12-01

Over 50 years ago, current tenets of distraction osteogenesis were developed through work on the lower extremity; however, the application of these tenets in the paediatric craniofacial skeleton remains questionable. Prompted by recent concern that traditional aspects of distraction may be either outdated or wholly inapplicable to the paediatric maxilla, we retrospectively evaluated maxillary distraction protocol using a 24-h latency period in conjunction with a distraction rate of 2mm/day. Following maxillary advancement via a distraction protocol consisting of a 24-h latency period and a distraction rate of 2mm/day, seven consecutive paediatric cases were evaluated. Standard profile photos and cephalometric films taken preoperatively, at device removal and at 1-year follow-up were compared. With the sella as the point of registration, pre- and post-distraction films were superimposed on the sella-nasion plane. Sella-nasion-subspinale, the angle of convexity, the distance from incisal edges to the y-axis, and angulation of the upper incisor to the sella-nasion plane were analysed to evaluate hard-tissue changes. Patient age ranged from 3 to 14 years (mean=7.43 years). Maxillary distraction length averaged 11 mm (range=10-12 mm). Interval from device application to removal averaged 98 days (range=75-180 days). The interval of the active distraction ranged from 11 to 65 days (mean=24 days). From distraction completion to device removal averaged 85 days (range=60-150). Follow-up intervals ranged from 52 to 24 months (mean=34 months). All patients demonstrated substantial clinical advancement of the maxilla with correction of midfacial deficiencies. A single patient developed mild cellulitis at one skin-device interface; no other complications were noted. Cephalometric and clinical evaluations at 1 year post-distraction demonstrated stable results, and parental satisfaction was qualitatively high. The surgical dogma of lower-extremity distraction osteogenesis is not

Variability of the inclination of anatomic horizontal reference planes of the craniofacial complex in relation to the true horizontal line in orthognathic patients.

Science.gov (United States)

Zebeib, Ameen M; Naini, Farhad B

2014-12-01

The purpose of this study was to assess the reliability of the Frankfort horizontal (FH), sella-nasion horizontal, and optic planes in terms of their variabilities in relation to a true horizontal line in orthognathic surgery patients. Thirty-six consecutive presurgical orthognathic patients (13 male, 23 female; age range, 16-35 years; 30 white, 6 African Caribbean) had lateral cephalometric radiographs taken in natural head position, with a plumb line orientating the true vertical line, and the true horizontal line perpendicular to the true vertical. The inclinations of the anatomic reference planes were compared with the true horizontal. The FH plane was found to be on average closest to the true horizontal, with a mean of -1.6° (SD, 3.4°), whereas the sella-nasion horizontal and the optic plane had means of 2.1° (SD, 5.1°) and 3.2° (SD, 4.7°), respectively. The FH showed the least variability of the 3 anatomic planes. The ranges of variability were high for all anatomic planes: -8° to 8° for the FH, -8° to 15° for the sella-nasion horizontal, and -6° to 13° for the optic plane. No significant differences were found in relation to patients' sex, skeletal patterns, or ethnic backgrounds. The clinically significant variability in the inclinations of anatomic reference planes in relation to the true horizontal plane makes their use unreliable in orthognathic patients. Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

The ectopic posterior pituitary gland

African Journals Online (AJOL)

2013-11-04

Nov 4, 2013 ... crinology with short stature, delayed bone age and biochemical features suggestive of hypo pituitarism. Magnetic resonance imaging of the brain demonstrated a flattened anterior pituitary gland within the sella, associated with absence of the infundibular stalk and an ectopic posterior pituitary gland (Fig.

Malformations of cranial base structures and pituitary gland in prenatal Meckel syndrome

DEFF Research Database (Denmark)

Kjaer, K W; Hansen, B F; Keeling, J W

1999-01-01

are constant phenotypic traits in MS. The adenohypophysis was present in three cases. In one of these, ectopia of the gland occurred with adenopituitary tissue overlying the dorsum sella, and in another remnants were found in the pharyngeal submucosa. In two fetuses the neurohypophysis was not found...

Functional Evaluation of TSH Secretory Reserve Capacity in Hypothalamo pituitary Disorders

Energy Technology Data Exchange (ETDEWEB)

Kim, Sun Yong; Choi, Kyoo Ok; Park, Chang Yun; Huh, Kab Bum; Ryu, Kyung Ja [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1979-03-15

The TRH stimulation test was known as a highly diagnostic method in hypothalamo pituitary disorders. To evaluate the location and the extension of the lesion, we estimated TSH response to TRH test in 27 patients. Correlation between volume of sella and TSH response was also studied. The results obtained were 25 follows: 1) In Sheehan's syndrome, TSH response after TRH test were not observed in all of 12 patients. 2) All 2 acromegaly patients showed normal TSH response. 3) In 4 cases of chromophobe adenoma, 2 cases showed no TSH response. In 2 responded cases, one patient whose tumor mass extended to suprasella region was hypothyroid state. 4) In craniopharyingioma 3 cases, the tumor which extended to intrasella showed hypothyroid and no TSH response. 5) Correlation between volume of sella and TSH response were valuable in 2 cases, but no diagnostic significance. 6) In diabetes inspidus, TSH response were all absent. 7) In primary amenorrhea, TSH response observed in 1 case, which conformed with isolated FSH deficiency.

Interstitial pituitary irradiation with 90Y for the treatment of acromomegaly

International Nuclear Information System (INIS)

Cassar, J.; Doyle, F.H.; Banks, L.M.; Jadresic, A.; Mashiter, K.; Joplin, G.F.

1981-01-01

The management of 54 acromegalics referred to us between 1974 and 1978 has been analysed. Twenty-two patients were treated with pituitary implants of yttrium-90 ( 90 Y). Eleven are in complete remission (mean growth hormone (GH) < 11 mlU/l), 8 had improved (mean GH 11-20 mlU/l or 50% less than preoperatively) and 3 were poor responders. Two patients had temporary 6th nerve paresis. Seven patients are on replacement therapy. Thirty- one patients were not implanted for the following reasons with a number of patients having more than one: extension of the tumour into the spehnoid sinus 10, or above the sella 3, partially empty sella 9, internal carotids too close to midline 2, invisible landmarks 1, mild acromegaly 6, poor general health 3, declined investigations or operation 6. It is concluded that pituitary implant of yttrium is an effective and safe form of treatment on carefully selected patients. (author)

Functional Evaluation of TSH Secretory Reserve Capacity in Hypothalamo pituitary Disorders

International Nuclear Information System (INIS)

Kim, Sun Yong; Choi, Kyoo Ok; Park, Chang Yun; Huh, Kab Bum; Ryu, Kyung Ja

1979-01-01

The TRH stimulation test was known as a highly diagnostic method in hypothalamo pituitary disorders. To evaluate the location and the extension of the lesion, we estimated TSH response to TRH test in 27 patients. Correlation between volume of sella and TSH response was also studied. The results obtained were 25 follows: 1) In Sheehan's syndrome, TSH response after TRH test were not observed in all of 12 patients. 2) All 2 acromegaly patients showed normal TSH response. 3) In 4 cases of chromophobe adenoma, 2 cases showed no TSH response. In 2 responded cases, one patient whose tumor mass extended to suprasella region was hypothyroid state. 4) In craniopharyingioma 3 cases, the tumor which extended to intrasella showed hypothyroid and no TSH response. 5) Correlation between volume of sella and TSH response were valuable in 2 cases, but no diagnostic significance. 6) In diabetes inspidus, TSH response were all absent. 7) In primary amenorrhea, TSH response observed in 1 case, which conformed with isolated FSH deficiency.

Studies on improvement of diagnosis of neurosurgical lesions by magnetic resonance imaging (MRI), 2; Advantages of MRI on diagnosis of parasellar lesions and comparison with X-ray CT

Energy Technology Data Exchange (ETDEWEB)

Shimizu, Kotoyuki (Kagoshima Univ. (Japan). Faculty of Medicine)

1989-05-01

Findings of magnetic resonance (MRI) imaging in 46 patients with sellar or parasellar mass were reviewed and compared with those of concurrently available X-ray CT. Intrasellar contents, the hypothalamic pituitary region, adjacent brain stem, optic nerves, and the surrounding cerebrospinal fluid were clearly depicted on T1-weighted images. The cavernous sinus and blood vessels, including the Willis circle, were visualized on T2-weighted images. In detecting pituitary macroadenoma, MRI seemed to be the most userful modality, because it was superior to CT in identifying abnormal changes of the infundibulum, diaphragma sellae, cavernous sinus and optic chiasm. Macroadenoma of the pituitary gland was usually isointense to the normal cerebral cortex on T1- and T2-weighted images. T1- and T2-weighted relaxation times for pituitary adenoma were slightly prolonged. The normal pituitary gland was distinguishable from adenomatous tissues. For microadenoma, MRI failed to show lesions or erosion of the sellar floor. Craniopharyngioma, meningioma of the tuberculum sellae, hypothalamic tumor, such as glioma and germinoma, and the other parasellar masses were clearly visualized on MRI. MRI was superior to CT in detecting tumor and its involvement, but inferior in detecting presence of calcification. T1-weighted imaging was useful in identifing the presence of intratumoral hemorrhage. Cysts of craniopharyngioma had various appearances on T1-weighted images. High signal cyst intensity corresponded to a high cholesterol content or the presence of methemoglobin. MRI depicted empty sella. The intrasellar content had the same appearance as that of the cerebrospinal fluid space, and the flattened pituitary gland and pituitary stalk were detected on T1-weighted images. (N.K.).

Studies on improvement of diagnosis of neurosurgical lesions by magnetic resonance imaging (MRI), 2

International Nuclear Information System (INIS)

Shimizu, Kotoyuki

1989-01-01

Findings of magnetic resonance (MRI) imaging in 46 patients with sellar or parasellar mass were reviewed and compared with those of concurrently available X-ray CT. Intrasellar contents, the hypothalamic pituitary region, adjacent brain stem, optic nerves, and the surrounding cerebrospinal fluid were clearly depicted on T1-weighted images. The cavernous sinus and blood vessels, including the Willis circle, were visualized on T2-weighted images. In detecting pituitary macroadenoma, MRI seemed to be the most userful modality, because it was superior to CT in identifying abnormal changes of the infundibulum, diaphragma sellae, cavernous sinus and optic chiasm. Macroadenoma of the pituitary gland was usually isointense to the normal cerebral cortex on T1- and T2-weighted images. T1- and T2-weighted relaxation times for pituitary adenoma were slightly prolonged. The normal pituitary gland was distinguishable from adenomatous tissues. For microadenoma, MRI failed to show lesions or erosion of the sellar floor. Craniopharyngioma, meningioma of the tuberculum sellae, hypothalamic tumor, such as glioma and germinoma, and the other parasellar masses were clearly visualized on MRI. MRI was superior to CT in detecting tumor and its involvement, but inferior in detecting presence of calcification. T1-weighted imaging was useful in identifing the presence of intratumoral hemorrhage. Cysts of craniopharyngioma had various appearances on T1-weighted images. High signal cyst intensity corresponded to a high cholesterol content or the presence of methemoglobin. MRI depicted empty sella. The intrasellar content had the same appearance as that of the cerebrospinal fluid space, and the flattened pituitary gland and pituitary stalk were detected on T1-weighted images. (N.K.)

CASE REPORT Cribriform pattern in brain MRI: A diagnostic clue for ...

African Journals Online (AJOL)

A 2-year-old boy presented with macrocephaly, initially suspected to be due to hydrocephalus. There were no focal neurological deficits. A 3T MRI of the brain, however, revealed macrocephaly, thickened diploeic spaces (most prominent in the occipital region) and the presence of a J-shaped sella (Fig. 1). A cribriform ...

CSF circulation in subjects with the empty sella syndrome

International Nuclear Information System (INIS)

Brismar, K.; Bergstrand, G.

1981-01-01

In the present study the CSF circulation was analyzed in 48 subjects with ESS with gamma cisternography, pneumoencephalography (PEG) und computed tomography (CT). In 80% of the subjects the CSF circulation was retarded with convexity block which was combined with widened CSF transport pathways and basal cisterns. These findings were correlated with the clinical signs and symptoms. Headache, psychiatric symptoms, visual field defects and obesity, however, were not related to the impaired CSF circulation. It is concluded that impaired CSF dynamics leading to intermittent increase of ICP has a major impact on the development of the ESS and that most of the patients' complaints are related to this disturbance. Thus is is important to obtain information of the CSF dynamics concurrent with the diagnosis of ESS. For this purpose PEG or CT may be used as the first examination. Moreover, the patient should be examined at least every second year for symptoms and signs of progressive impairments of the CSF circulation. (orig./MG)

Functional Evaluation of TSH Secretory Reserve Capacity in Hypothalamo pituitary Disorders

Energy Technology Data Exchange (ETDEWEB)

Kim, Sun Yong; Choi, Kyoo Ok; Park, Chang Yun; Huh, Kab Bum; Ryu, Kyung Ja [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1979-03-15

The TRH stimulation test was known as a highly diagnostic method in hypothalamo pituitary disorders. To evaluate the location and the extension of the lesion, we estimated TSH response to TRH test in 27 patients. Correlation between volume of sella and TSH response was also studied. The results obtained were 25 follows: 1) In Sheehan's syndrome, TSH response after TRH test were not observed in all of 12 patients. 2) All 2 acromegaly patients showed normal TSH response. 3) In 4 cases of chromophobe adenoma, 2 cases showed no TSH response. In 2 responded cases, one patient whose tumor mass extended to suprasella region was hypothyroid state. 4) In craniopharyingioma 3 cases, the tumor which extended to intrasella showed hypothyroid and no TSH response. 5) Correlation between volume of sella and TSH response were valuable in 2 cases, but no diagnostic significance. 6) In diabetes inspidus, TSH response were all absent. 7) In primary amenorrhea, TSH response observed in 1 case, which conformed with isolated FSH deficiency.

I pionieri italiaNi della geofisiCa

Directory of Open Access Journals (Sweden)

P. CALOI

1964-06-01

Full Text Available Vengono rapidamente passati in rassenga, seguendo
l'ordine cronologico, gli studiosi di geofisica — intesa in senso lato — clie,
a partire dalla seconda meta del Settecento, ebbero ad interessarsi in Italia
di elettricita atmosferica, magnetismo terrestre, idrografla, oceanografia fisica,
sismologia e vulcanologia, con intenti pionieristici. Sono ricordati i principali
risultati raggiunti da una trentina di ricercatori fra i quali spiccano, per la
vastita del lavoro compiuto e per la novita dei risultati, Leopoldo Nobili e Macedonio
Melloni. Ma, ciascuno nei suo campo, scoperte di rilievo fecero pure
G. B. Beccaria, Luigi Palmieri, Carlo Matteucci, Timoteo Bertelli, Luigi De
Marcbi, Carlo Somigliana, Emilio Oddone, Alfonso Sella e Domenico Pacini.
Alcuni vantano priorita di rilievo: scoperta della doppia oscillazione diurna
del barometro (Chiminello, 1780; unicita sorgiva delle varie radiazioni dello
spettro (M. Melloni; sismografo elettromagnetico a registrazione continua
(Palmieri, 1855; microsismi (Bertelli, 1872; il paleomagnetismo (Oddone e
Sella, 1891; la radiazione cosmica (Pacini, 1910; . ..

[Unconsciousness due to hyponatremia in a patient with short stature with panhypopituitarism].

Science.gov (United States)

Notsu, K; Takagi, C; Umaki, I

1995-03-20

An unconscious woman of short stature (141 cm) was admitted to our hospital in March, 1994. She had hyponatremia (120 mEq/l) and had experienced massive bleeding during delivery. No increment of either plasma ACTH or cortisol levels was observed after insulin-induced hypoglycemia. However, urinary 17OHCS levels gradually increased after repeated intramuscular injections of ACTH. Plasma free T3 and free T4 levels were low. Neither plasma TSH nor prolactin (PRL) levels increased after an intravenous injection of TRH. Basal plasma LH, FSH and growth hormone (GH) levels were low and there were no observable responses to any of the stimulation tests. A magnetic resonance image (MRI) of her pituitary gland showed an empty sella. These results showed that she had a panhypopituitarism with primary empty sella. Replacement therapy with glucocorticoid was started and serum sodium levels normalized immediately. Levothyroxine was also administered. The possibility of pituitary dwarfism during her youth and a gradual postpartum reduction of other pituitary hormones may have caused an impairment of the hypothalamo-pituitary-adrenal axis.

Cirurgia da hipófise por via trans-esfenoidal sob controle radiofluoroscópico e microdissecção novo tratamento da retinopatia diabética, tumores selares e neoplasias endocrinodependentes The surgery of the pituitary gland using a transphenoidal approach under radiofluoroscopic control and microdisection: a new treatment for diabetic retinopathy, pituitary tumors and endocrinodependent growths

Directory of Open Access Journals (Sweden)

Jules Hardy

1968-03-01

Full Text Available É apresentada nova técnica para a ablação total ou seletiva da hipófise utilizando via de acesso trans-esfenoidal, controle radiofluoroscópico e microdissecção, com traumatismo desprezível às estruturas circunvizinhas. Os autores comentam as aplicações do método à prática neurocirúrgica, relatando parte de uma série de mais 140 casos já operados. São discutidos os resultados obtidos no tratamento de 17 casos de retinopatia diabética, em 11 dos quais apenas o lobo anterior da hipófise foi removido, assim como aqueles obtidos na exérese de 20 casos de tumores selares. As indicações da hipofisectomia por via trans-esfenoidal no controle da sintomatologia das neoplasias endòcrinodependentes é estudada à luz dos resultados obtidos em 17 casos, sendo os resultados comparados com casos nos quais foi feita a implantação selar de ítrio90. As complicações operatorias em relação às três entidades nosológicas acima estudadas são também analisadas. Os autores salientam que a técnica descrita constitui, no presente estado das técnicas neurocirúrgicas utilizadas para a produção de uma insuficiência hipofisária duradoura, a intervenção de escolha.A new neurosurgical technique for the partial or total exéresis of the pituitary gland, using a transphenoidal approach under radiofluoroscopic control and microdisection is described. Part of a series of more than 140 cases operated upon by this method is reported. Results obtained in the treatment of diabetic retinopathy in 17 cases, 11 of which had only the pars anterior removed, are discussed. The applications of the transphenoidal route in 20 cases of pituitary fossa tumors are analysed. The indications of this type of operation in the management of endocrinodependent cancer is studied in 17 cases and compared with the results of 36 cases submitted to implant of Yttrium90 in the sella turcica. The operative complications following transphenoidal exéresis of the

The value of high-field MRI (3 T) in the assessment of sellar lesions

Energy Technology Data Exchange (ETDEWEB)

Pinker, K. [Department of Diagnostic Radiology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Ba-Ssalamah, A. [Department of Diagnostic Radiology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Wolfsberger, S. [Department of Neurosurgery, Medical University Vienna (Austria); Mlynarik, V. [Department of Diagnostic Radiology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Knosp, E. [Department of Neurosurgery, Medical University Vienna (Austria); Trattnig, S. [Department of Diagnostic Radiology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria)]. E-mail: siegfried.trattnig@univie.ac.at

2005-06-01

The aim of this study was the evaluation of the normal sellar anatomy in vitro and in vivo with high-field MRI and its application in the diagnosis of sellar pathologies in comparison to standard MRI. All high-field MR images were obtained using a 3 T Bruker Medspec 30/80 Scanner with a head birdcage transmit/receive coil and an actively shielded gradient system with a maximum gradient strength of 45 mT/m. Firstly an in vitro study of the sella turcica was performed to depict normal pituitary and sellar anatomy at high field. After a pilot-study this sequence-protocol was established: A RARE sequence (TR/TE = 7790/19 ms; matrix size, 512 x 512; RARE factor = 8, FOV, 200 mm) was used for T2-weighted coronal, axial and sagittal images. A 3D gradient echo sequence with magnetization-preparation (MP-RAGE, TR/TE/TI 33.5/7.6/800 ms, matrix size, 512 x 512; FOV, 200 mm, effective slice thickness, 1.88 mm; 3 averages) was used for acquisition of T1-weighted pre- and post-contrast images. Between January 2002 and March 200458 patients were enrolled in this study. Seven patients were examined for suspected microadenoma and in 51 patients 3T MRI was used to obtain additional information about the sellar lesion already known to be present from standard MRI. In 21 cases the accuracy of the imaging findings was assessed afterwards by comparison with intraoperative findings. The infiltration of the medial cavernous sinus wall was suspected on standard MRI on 15 sides (47%), on high-field MRI on 9 sides (28%) and could be verified by intraoperative findings on 6 sides (19%). Accordingly, sensitivity to infiltration was 83% for 3 T and 67% for standard MRI. Specificity was 84% for 3 T and 58% for standard MRI. Moreover, high-field MRI revealed microadenomas in 7 patients with a median diameter of 4 mm (range 2-9 mm). The segments of the cranial nerves were seen as mean 4 hypointense spots (range 2-5 spots) on high-field MRI in contrast to 3 spots (range 0-4 spots) on standard MRI

Radiologically defining horizontal gaze using EOS imaging-a prospective study of healthy subjects and a retrospective audit.

Science.gov (United States)

Hey, Hwee Weng Dennis; Tan, Kimberly-Anne; Ho, Vivienne Chien-Lin; Azhar, Syifa Bte; Lim, Joel-Louis; Liu, Gabriel Ka-Po; Wong, Hee-Kit

2018-06-01

As sagittal alignment of the cervical spine is important for maintaining horizontal gaze, it is important to determine the former for surgical correction. However, horizontal gaze remains poorly-defined from a radiological point of view. The objective of this study was to establish radiological criteria to define horizontal gaze. This study was conducted at a tertiary health-care institution over a 1-month period. A prospective cohort of healthy patients was used to determine the best radiological criteria for defining horizontal gaze. A retrospective cohort of patients without rigid spinal deformities was used to audit the incidence of horizontal gaze. Two categories of radiological parameters for determining horizontal gaze were tested: (1) the vertical offset distances of key identifiable structures from the horizontal gaze axis and (2) imaginary lines convergent with the horizontal gaze axis. Sixty-seven healthy subjects underwent whole-body EOS radiographs taken in a directed standing posture. Horizontal gaze was radiologically defined using each parameter, as represented by their means, 95% confidence intervals (CIs), and associated 2 standard deviations (SDs). Subsequently, applying the radiological criteria, we conducted a retrospective audit of such radiographs (before the implementation of a strict radioimaging standardization). The mean age of our prospective cohort was 46.8 years, whereas that of our retrospective cohort was 37.2 years. Gender was evenly distributed across both cohorts. The four parameters with the lowest 95% CI and 2 SD were the distance offsets of the midpoint of the hard palate (A) and the base of the sella turcica (B), the horizontal convergents formed by the tangential line to the hard palate (C), and the line joining the center of the orbital orifice with the internal occipital protuberance (D). In the prospective cohort, good sensitivity (>98%) was attained when two or more parameters were used. Audit using Criterion B

Pure intrasellar meningioma located under the pituitary gland: Case report

International Nuclear Information System (INIS)

Cha, Seung Woo; Park, Dong Woo; Park, Choong Ki; Pyo, Ju Yeon; Lee, Young Jun; Lee, SAeung Ro

2013-01-01

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.

Pure intrasellar meningioma located under the pituitary gland: Case report

Energy Technology Data Exchange (ETDEWEB)

Cha, Seung Woo; Park, Dong Woo; Park, Choong Ki; Pyo, Ju Yeon [College of Medicine, Hanyang University, Guri Hospital, Guri (Korea, Republic of); Lee, Young Jun; Lee, SAeung Ro [Dept. of Radiology, College of Medicine, Hanyang University, Seoul (Korea, Republic of)

2013-04-15

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.

Fat deposition in the cavernous sinus in Cushing disease

International Nuclear Information System (INIS)

Bachow, T.B.; Hesselink, J.R.; Aaron, J.O.; Davis, K.R.; Taveras, J.M.

1984-01-01

Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 (37.5%) patients with Cushing disease. This finding may aid in making a specific diagnosis in patients with a pituitary mass. It was not seen in 30 random CT studies of the sella; however, supra seller fat was incidentally noted in the patient with acromegaly

Fat deposition in the cavernous sinus in Cushing disease

Energy Technology Data Exchange (ETDEWEB)

Bachow, T.B.; Hesselink, J.R.; Aaron, J.O.; Davis, K.R.; Taveras, J.M.

1984-10-01

Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 (37.5%) patients with Cushing disease. This finding may aid in making a specific diagnosis in patients with a pituitary mass. It was not seen in 30 random CT studies of the sella; however, supra seller fat was incidentally noted in the patient with acromegaly.

Hypothalamic-pituitary dwarfism: Comparison between MR imaging and CT findings

International Nuclear Information System (INIS)

Maghnie, M.; Larizza, D.; Severi, F.; Triulzi, F.; Scotti, G.; Beluffi, G.; Cecchini, A.

1990-01-01

Magnetic Resonance (MR) imaging was carried out on 33 patients with idiopathic growth hormone deficiency, in 22 of whom CT scan had been carried out previously. Twenty-one patients presented some complications at birth. Both MR and CT were positive in the evaluation of the sella. MR imaging exhibited a higher degree of accuracy than CT in the evaluation of pituitary gland, pituitary stalk and brain anomalies. (orig.)

Stability Following Combined Maxillary and Mandibular Osteotomies Treated with Rigid Internal Fixation.

Science.gov (United States)

1987-06-01

S), articulare (Ar), A point, B point, constructed gonion (CGo), and menton (Me). The points nasion and sella were transferred to each successive...radiograph by superimposing on anterior and posterior cranial base structures. The landmarks articulare , A point, B point, menton, and constructed gonion...reported 45% relapse in their cases determined to be attributed to condylar distraction at the time of surgery. The use of rigid fixation as described

A CASE REPORT ON SHEEHAN’S SYNDROME WITH IRON DEFICIENCY ANAEMIA- A HAEMATOLOGICAL PERSPECTIVE OF PANHYPOPITUITARISM

Directory of Open Access Journals (Sweden)

Usha Rani Pegu

2017-04-01

Full Text Available BACKGROUND SS occurs due to ischaemic pituitary necrosis after severe Postpartum Haemorrhage (PPH and is characterised by typical history of severe postpartum blood loss, hypotension or shock, postpartum lactation failure, discontinuation of the menses after the delivery, partial or complete anterior pituitary insufficiency and empty sella on CT or MRI. 1,2,3,4 Although unclear, anaemia is well recognised as a feature of hypopituitarism.

The International Conference on Hemorrhagic Fever with Renal Syndrome (1st) Held in Seoul, Korea on 4-6 May 1989

Science.gov (United States)

1990-05-01

suggest that the body is important for a maker of 1lFRS-virus infection. 69 PROSPECTIVE STUDY ON PANHYPOPITUITARISM AS A SEQUELA OF HEMORRHAGIC FEVER...necrosis is a characteristic and common autopsy finding. Contrary to this, only 14 cases of clinical panhypopituitarism have been reported. Recently we...confirmed six patients with panhypopituitarism by high resolution sella computed tomo-,raphy(CT) and combined anterior pituitary stimulation lest(CAPS I

MR imaging in children with ectopic pituitary gland and anterior hypopituitarism.

OpenAIRE

Patkar D; Patankar T; Krishnan A; Prasad S; Shah J; Limdi J

1999-01-01

Posterior pituitary ectopia refers to an absent normal posterior pituitary bright spot within the sella with ectopic bright signal at another site (such as the median eminence) on a weighted magnetic resonance. We describe two children with idiopathic anterior hypopituitarism who showed an ectopic posterior pituitary and absent pituitary stalk on imaging. We emphasize the association of the absent pituitary stalk in ectopic pituitary gland and low growth hormone levels.

Extramedullary plasmocytoma of the rhino pharynx associated to intrathoracic mass - a case report

International Nuclear Information System (INIS)

Souza, Andrea Silveira de; Fernandes, Artur da Rocha Correa; Yamashita, Helio Kiitiro

1996-01-01

The authors report a case of a 56-year-old while male, who had occipital headache, libido and visual acuity (bitemporal field) reduction as the clinical picture, with progressive evolution within a four years period. The image diagnosis methods (roentgenologic studies, (MRI) demonstrated extensive mass involving the sella, clivus and sphenoid sinus, and an intrathoracic mass on the right. The final diagnosis was extramedullary plasmocytoma with rhinopharynx origin. (author)

Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma.

Science.gov (United States)

Wang, Xian-Ling; Dou, Jing-Tao; Lü, Zhao-Hui; Zhong, Wen-Wen; Ba, Jian-Ming; Jin, Du; Lu, Ju-Ming; Pan, Chang-Yu; Mu, Yi-Ming

2011-11-01

Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma. Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed. In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher, but nadir GH levels were all still > 1 µg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission. When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.

MR imaging in children with ectopic pituitary gland and anterior hypopituitarism.

Directory of Open Access Journals (Sweden)

Patkar D

1999-07-01

Full Text Available Posterior pituitary ectopia refers to an absent normal posterior pituitary bright spot within the sella with ectopic bright signal at another site (such as the median eminence on a weighted magnetic resonance. We describe two children with idiopathic anterior hypopituitarism who showed an ectopic posterior pituitary and absent pituitary stalk on imaging. We emphasize the association of the absent pituitary stalk in ectopic pituitary gland and low growth hormone levels.

Significant Improvement in Chronic Persistent Headaches Caused by Small Rathke Cleft Cysts After Transsphenoidal Surgery

OpenAIRE

Fukui, Issei; Hayashi, Yasuhiko; Kita, Daisuke; Sasagawa, Yasuo; Oishi, Masahiro; Tachibana, Osamu; Nakada, Mitsutoshi

2017-01-01

Purpose Rathke cleft cysts (RCC) usually are asymptomatic and can be observed via the use of conservative methods. Some patients with RCCs, however, have severe headaches even if they are small enough to be confined to the sella, and these small RCCs seldom have been discussed. This study presents an investigation into clinical characteristics of small RCCs associated with severe headaches, demonstrating efficacy and safety of endoscopic transsphenoidal surgery (ETSS) to relieve headaches. Me...

Effect of Maize Hybrid and Foliar Fungicides on Yield Under Low Foliar Disease Severity Conditions.

Science.gov (United States)

Mallowa, Sally O; Esker, Paul D; Paul, Pierce A; Bradley, Carl A; Chapara, Venkata R; Conley, Shawn P; Robertson, Alison E

2015-08-01

Foliar fungicide use in the U.S. Corn Belt increased in the last decade; however, questions persist pertaining to its value and sustainability. Multistate field trials were established from 2010 to 2012 in Illinois, Iowa, Ohio, and Wisconsin to examine how hybrid and foliar fungicide influenced disease intensity and yield. The experimental design was in a split-split plot with main plots consisting of hybrids varying in resistance to gray leaf spot (caused by Cercospora zeae-maydis) and northern corn leaf blight (caused by Setosphaera turcica), subplots corresponding to four application timings of the fungicide pyraclostrobin, and sub-subplots represented by inoculations with either C. zeae-maydis, S. turcica, or both at two vegetative growth stages. Fungicide application (VT/R1) significantly reduced total disease severity relative to the control in five of eight site-years (P<0.05). Disease was reduced by approximately 30% at Wisconsin in 2011, 20% at Illinois in 2010, 29% at Iowa in 2010, and 32 and 30% at Ohio in 2010 and 2012, respectively. These disease severities ranged from 0.2 to 0.3% in Wisconsin in 2011 to 16.7 to 22.1% in Illinois in 2010. The untreated control had significantly lower yield (P<0.05) than the fungicide-treated in three site-years. Fungicide application increased the yield by approximately 6% at Ohio in 2010, 5% at Wisconsin in 2010 and 6% in 2011. Yield differences ranged from 8,403 to 8,890 kg/ha in Wisconsin 2011 to 11,362 to 11,919 kg/ha in Wisconsin 2010. Results suggest susceptibility to disease and prevailing environment are important drivers of observed differences. Yield increases as a result of the physiological benefits of plant health benefits under low disease were not consistent.

Intrasellar Symptomatic Salivary Gland Rest

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Chih-Hao Chen

2007-05-01

Full Text Available Ectopic salivary gland tissue in sellar turcica is frequently observed in microscopic examination at autopsy. This tissue is considered clinically silent. Only 2 symptomatic cases have been previously reported. Here we report a 28-year-old woman presenting with galactorrhea and hyperprolactinemia. Magnetic resonance imaging revealed a 6×5-mm nodule in the posterior aspect of the pituitary gland. This nodule showed isointensity on T1- and T2-weighted images and less enhancement on post-contrast T1-weighted images. Transsphenoidal exploration revealed a cystic lesion within the pituitary gland, which consisted of a grayish gelatinous content. The pathologic examination confirmed the diagnosis of salivary gland rest.

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center.

Science.gov (United States)

Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Ferraz, Tania

2010-10-01

Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Endoscopic transsphenoidal surgery represents an effective option for treatment of patients

Mobile Officen sisustussuunnitelma : Rytmikorjaamon liikkuvan ihmisen työpisteet

OpenAIRE

Talvitie, Satu

2011-01-01

Opinnäytetyö käsitteli toimistotilan sisustussuunnittelua luovan tilan konseptilla. Työn tarkoituksena oli antaa selkeä kuva sisustussuunnittelusta, toimistosuunnittelusta ja luovan tilan merkityksestä. Opinnäytetyön tavoitteena oli tehdä sisustussuunnitelma Rytmikorjaamon Mobile Officeen. Mobile Office tehdään liikkuvien ihmisten työpisteiksi. Opinnäytetyön toimeksiantajana toimivat Sisustuskeskus Sella, Seinäjoen kaupunki, Selmu Ry ja Seinäjoen teknologiakeskus. Opinnäytetyön teoriaosuud...

A transseptal approach in transsphenoidal surgery for pituitary (hypophyseal) tumors

International Nuclear Information System (INIS)

Gierek, T.; Galuszko-Ignasiak, B.; Krauze, J.; Rudnik, A.

1994-01-01

The authors described the direct transseptal approach in transsphenoidal surgery for hypophyseal tumors. This route gives a good insight into the area of the sella. The above mentioned method is also less destructive to nasal structures in the nasal cavity, because preserves the anterior nasal septum. It is uniformity of actually views of rhinological school. 20 patients were operated using this method and none of them noticed the changes of nasal airway and the sense of smell. (author)

MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma

International Nuclear Information System (INIS)

Lakhanpal, S.K.; Glasier, C.M.; James, C.A.; Angtuaco, E.J.C.

1995-01-01

We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7 % of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. (orig.)

MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma

Energy Technology Data Exchange (ETDEWEB)

Lakhanpal, S.K. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); Glasier, C.M. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); James, C.A. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); Angtuaco, E.J.C. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States)

1995-06-01

We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7 % of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. (orig.)

Lymphocytic hypophysitis and hypothalamitis - a case report

International Nuclear Information System (INIS)

Stelmachowska, M.; Bolko, P.; Wasko, R.; Sowinski, J.; Kosinski, D.; Towpik, I.

2006-01-01

Lymphocytic hypophysitis is an unusual disorder that nearly exclusively affects women. We present a case of 69 year-old female patient who developed the symptoms of diabetes insipidus and partial insufficiency of the anterior pituitary gland. Magnetic resonance imaging of the brain revealed a mass involving the sella and suprasellar region. After exclusion of other causes of infiltrate in this region and due to evident reaction to glucocorticoid treatment the diagnosis of lymphocytic hypophisitis and hypothalamitis was established. (author)

Allasterapia osana neurologista kuntoutusta

OpenAIRE

Laaksonen, Aino; Lahti, Janina; Saastamoinen, Maarit; Salmi, Sirja

2009-01-01

Opinnäytetyön tarkoituksena oli koota teoriatietoa allasterapiasta ja erityisesti sen soveltuvuudesta neurologisille kuntoutujille. Opinnäytetyö toteutettiin vuoden 2009 aikana. Opinnäytetyön aineisto koottiin kirjallisuuskatsauksen ja avoimen teemahaastattelun avulla. Kirjallisuutta ja tutki-mustietoa neurologisesta allasterapiasta on vähän, ja se irrallista, joten teemahaastatteluista laaditulla vapaamuotoi-sella yhteenvedolla opinnäytetyöhön saatiin mukaan myös käytännönkokemuksia. Opinnäy...

Identification of 'Point A' as the prevalent source of error in cephalometric analysis of lateral radiographs.

Science.gov (United States)

Grogger, P; Sacher, C; Weber, S; Millesi, G; Seemann, R

2018-04-10

Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters. Cephalometric analysis was automatically performed based on 1116 tracings. Error analysis identified the x-coordinate of Point A as the prevalent source of error in all investigated measurements, except SNB, in which it is not incorporated. In SNB, the y-coordinate of Nasion predominated error variance. SNB showed lowest inter-rater variation. In addition, our observations confirmed previous studies showing that landmark identification variance follows characteristic error envelopes in the highest number of tracings analysed up to now. Variance orthogonal to defining planes was of relevance, while variance parallel to planes was not. Taking these findings into account, orthognathic surgeons as well as orthodontists would be able to perform cephalometry more accurately and accomplish better therapeutic results. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing. A consequence of idiopathic intracranial hypertension?

Energy Technology Data Exchange (ETDEWEB)

Urbach, H.; Jamneala, G.; Mader, I.; Egger, K.; Yang, S. [Medical Center - Freiburg Univ. (Germany). Dept. of Neuroradiology; Altenmueller, D. [Medical Center - Freiburg Univ. (Germany). Dept. of Epileptology

2018-01-15

Antero-inferior temporal lobe meningoencephaloceles are a rare, but increasingly recognized cause of drug-resistant temporal lobe epilepsy (TLE). In order to evaluate whether these lesions are related to idiopathic intracranial hypertension (IIH), we analyzed clinical and MRI findings of a cohort of patients undergoing presurgical work-up. Seizure onset in the anterior temporal lobe was proven by EEG electrodes in 22 patients, and in 21 patients, anterior temporal lobectomy (mostly with sparing of the hippocampus) was performed. MRI signs of IIH (in particular empty sella) and the volumes of the ventricles and external CSF spaces were determined and related to the body mass index (BMI) and clinical outcome. Six of seven obese (BMI > 30 kg/m{sup 2}) compared to four of 15 non-obese patients had partial empty or empty sella (p = 0.007). Bilateral lesions were found in all obese and 11 patients. Seizure freedom (Engel class 1A) was achieved in 12 of 21 patients (5 obese compared to 7 non-obese patients). BMI was related to the volume of the external CSF spaces (r = 0.467), and age at seizure onset was higher in obese patients. Roughly a third of patients with temporal lobe epilepsy due to antero-inferior meningoencephaloceles is obese and has MRI signs of idiopathic intracranial hypertension. (orig.)

Manual tracing versus smartphone application (app) tracing: a comparative study.

Science.gov (United States)

Sayar, Gülşilay; Kilinc, Delal Dara

2017-11-01

This study aimed to compare the results of conventional manual cephalometric tracing with those acquired with smartphone application cephalometric tracing. The cephalometric radiographs of 55 patients (25 females and 30 males) were traced via the manual and app methods and were subsequently examined with Steiner's analysis. Five skeletal measurements, five dental measurements and two soft tissue measurements were managed based on 21 landmarks. The durations of the performances of the two methods were also compared. SNA (Sella, Nasion, A point angle) and SNB (Sella, Nasion, B point angle) values for the manual method were statistically lower (p < .001) than those for the app method. The ANB value for the manual method was statistically lower than that of app method. L1-NB (°) and upper lip protrusion values for the manual method were statistically higher than those for the app method. Go-GN/SN, U1-NA (°) and U1-NA (mm) values for manual method were statistically lower than those for the app method. No differences between the two methods were found in the L1-NB (mm), occlusal plane to SN, interincisal angle or lower lip protrusion values. Although statistically significant differences were found between the two methods, the cephalometric tracing proceeded faster with the app method than with the manual method.

Research on atmospheric radioactivity. [In French

Energy Technology Data Exchange (ETDEWEB)

Garrigue, H

1954-01-01

In flight at 2800 m, traces of radioactive particles were gathered, by means of a corona effect similar to that of Sella, and of long period, on April 24, 1954. At Puy-de-Dome (1465 m) after a fall of rain and snow on May 3 to 4, 1954, samples of the fallen residue showed very feeble radioactivity of period 10 days or more. This radioactivity of the airborne particles was independent of their probable natural electrical charge and mobility and was indicative of an atomic cloud.

MR findings in pituitary haemosiderosis

International Nuclear Information System (INIS)

Ambrosetto, P.; Zucchini, S.; Cicognani, A.; Cacciari, E.

1998-01-01

A girl with Diamond-Blackfan syndrome and hypopituitarism was suspected of having pituitary haemosiderosis because of the clinical picture and the long history of blood transfusions. On T1-weighted MR images the pituitary exhibited a markedly hypointense anterior lobe (mimicking the empty sella), suggesting iron deposition, while on T2W MRI the low signal of the pituitary was surrounded by the high signal of the CSF. MR may be considered the examination of choice for detecting iron overload in the pituitary. (orig.)

Pseudotumor Cerebri Resulting in Empty Sella Syndrome and Multiple Pituitary Hormone Deficiencies

Science.gov (United States)

2017-09-16

REPORT TYPE 09/16/2017 Poster 4. TITLE AND SUBTITLE Pseudotu1nor Cercbri Rc~ulling in E1npty ~ella Syndrome and J\\ilultiple Pituitary Honnone...Sc. PROGRAM ELEMENT NUMBER Sd. PROJECT NUMBER Se. TASK NUMBER Sf. WORK UNIT NUMBER 8. PERFORMING ORGANIZATION REPORT NUMBER 17352 10. SPONSOR

Spontaneous reossification of the sella in transsphenoidal reoperation associated with strontium ranelate

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Maria Mercedes Pineyro

2017-07-01

Full Text Available Spontaneous reossification of the sellar floor after transsphenoidal surgery has been rarely reported. Strontium ranelate, a divalent strontium salt, has been shown to increase bone formation, increasing osteoblast activity. We describe an unusual case of a young patient with Cushing’s disease who was treated with strontium ranelate for low bone mass who experienced spontaneous sellar reossification after transsphenoidal surgery. A 21-year-old male presented with Cushing’s features. His past medical history included delayed puberty diagnosed at 16 years, treated with testosterone for 3 years without further work-up. He was diagnosed with Cushing’s disease initially treated with transsphenoidal surgery, which was not curative. The patient did not come to follow-up visits for more than 1 year. He was prescribed strontium ranelate 2 g orally once daily for low bone mass by an outside endocrinologist, which he received for more than 1 year. Two years after first surgery he was reevaluated and persisted with active Cushing’s disease. Magnetic resonance image revealed a left 4 mm hypointense mass, with sphenoid sinus occupation by a hyperintense material. At repeated transsphenoidal surgery, sellar bone had a very hard consistency; surgery was complicated and the patient died. Sellar reossification negatively impacted surgery outcomes in this patient. While this entity is possible after transsphenoidal surgery, it remains unclear whether strontium ranelate could have affected sellar ossification.

MRT in differentiation between tumour and implant material in the postoperative sella

International Nuclear Information System (INIS)

Kaiser, W.A.; Steckelbroeck, V.; Siewert, B.; Layer, G.; Hochstetter, A.; Reiser, M.

1993-01-01

MRT criteria have been developed to distinguish between tumour and implant material following examination of 50 patients who had transsphenoidal hypophysectomies for tumours. Judgements were based on the postoperative hormonal status and the operation notes. Following contrast injection of Gd-DTPA and using T 1 weighted spin-echo sequences, implant material appeared as sandwich-like, linear or circular structures. Residual recurrent tumour produced homogenous or non-homogenous aspects without marginal enhancement in 84% of cases. Postoperative displacement of the infundibulum to the opposite side was observed in 73% of patients with tumour remnants. Sensitivity of MRT was 70%, specificity 95%. There was a positive predictive value of 94% and a negative predictive value of 72% with an accuracy of 81%. This provides assistance in differentiating between tumour remnants and implant material. MRT is recommended as a method of examination for hypophyseal tumours to evaluate the success of surgery and where there is clinical doubt concerning residual or recurrent tumour. (orig.) [de

Microscopic and endoscopic anatomical study of the extended transsphenoidal approach

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HUANG Xin-tao

2013-06-01

Full Text Available Background Traditional transsphenoidal approach has less treatment effect in invasive pituitary adenoma. To remove tumors growing outside the sella become one of the challenges in neurosurgery. This study aims to study anatomical characteristics of the extended transsphenoidal approach for clinical operation. Methods A mimetic surgery was performed on 10 adult cadaver heads through extended transsphenoidal approach by endoscopy. The study data of related anatomic structures were measured. Results The distance from sphenoidal ostium to anterior nasal spine is (59.68 ± 4.28 mm (52.62-63.16 mm, to posterior nasal aperture is (12.88 ± 1.46 mm (10.47-15.61 mm. The incidence of optic nerve and internal carotid artery protuberance in the lateral wall of sphenoidal sinus is 11/20 and 17/20, respectivly. The medial wall of the cavernous sinus is comprised of one dural layer. The incidence of anterior intercavernous sinus, posterior intercavernous sinus, inferior intercavernous sinus and basilar sinus is 17/20, 12/20, 11/20 and 20/20, respectively. The distance between the bilateral hidden segment of internal carotid artery is (15.30 ± 1.25 mm (12.42-21.76 mm, between the bilateral inferior horizontal segment midpoint is (14.03 ± 1.19 mm (10.42-18.43 mm, between the bilateral anterior vertical segment is (18.87 ± 1.44 mm (16.75-24.88 mm, and between the bilateral inner edge of tuberculum sellae is (12.73 ± 0.94 mm (9.97-16.18 mm. In 7 cases (7/20, the intracavernous carotid is in direct contact with the sellar part of the medial wall; in all cases (20/20, the venous plexus extends into the space between the intracavernous carotid and the sphenoidal part of the medial wall. The incidence of the intracavernous carotid coursing along the inferior one third of the pituitary gland is 9/20, along the inferior two thirds of the pituitary gland is 7/20, along the all the thirds of the pituitary gland is 3/20, while below the level of the sellar floor is

Postnatal treatment factors affecting craniofacial morphology of unilateral cleft lip and palate (UCLP) patients in a Japanese population.

Science.gov (United States)

Alam, M K; Iida, J; Sato, Y; Kajii, Takashi S

2013-12-01

We have evaluated the craniofacial morphology of Japanese patients with unilateral cleft lip and palate (UCLP) and assessed the various postnatal factors that affect it. Lateral cephalograms of 140 subjects (mean (SD) aged 7 (2) years) with UCLP were taken before orthodontic treatment. Surgeons from Hokkaido University Hospital had done the primary operations. The craniofacial morphology was assessed by angular and linear cephalometric measurements. Cheiloplasty, palatoplasty, and preoperative orthopaedic treatment were chosen as postnatal factors. To compare the assessments of the postnatal factors, we made angular and linear cephalometric measurements for each subject and converted them into Z scores in relation to the mean (SD) of the two variables. Subjects treated by the modified Millard cheiloplasty had larger sella-nasion-point A (SNA) and nasion-point A-pogonion (NA-POG) measurements than subjects treated by the modified Millard with a vomer flap cheiloplasty. Two-stage palatoplasty showed consistently better craniofacial morphology than the other palatoplasty. Subjects who had preoperative orthopaedic treatment with a Hotz plate had significantly larger upper incisor/sella-nasion (U1-SN) measurements than who had no preoperative orthopaedic treatment or an active plate. We conclude that in subjects treated by a modified Millard type of cheiloplasty, a two-stage palatoplasty, and a Hotz plate there were fewer adverse effects on craniofacial morphology. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension

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Maralani, P.J. [Section of Neuroradiology, Department of Diagnostic Imaging, Ottawa Hospital, Ottawa, Ontario (Canada); Hassanlou, M. [Department of Ophthalmology, Ottawa Hospital, Ottawa, Ontario (Canada); Torres, C.; Chakraborty, S.; Kingstone, M. [Section of Neuroradiology, Department of Diagnostic Imaging, Ottawa Hospital, Ottawa, Ontario (Canada); Patel, V.; Zackon, D. [Department of Ophthalmology, Ottawa Hospital, Ottawa, Ontario (Canada); Bussiere, M., E-mail: mbussiere@toh.on.ca [Section of Neuroradiology, Department of Diagnostic Imaging, Ottawa Hospital, Ottawa, Ontario (Canada); Division of Neurology, Department of Medicine, Ottawa Hospital, Ottawa, Ontario (Canada)

2012-07-15

Aim: To investigate the accuracy of individual and combinations of signs on brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in the diagnosis of idiopathic intracranial hypertension (IIH). Materials and methods: This study was approved by the institutional research ethics board without informed consent. Forty-three patients and 43 control subjects were retrospectively identified. Each patient and control had undergone brain MRI and MRV. Images were anonymized and reviewed by three neuroradiologists, blinded to clinical data, for the presence or absence of findings associated with IIH. The severity of stenosis in each transverse sinus was graded and summed to generate a combined stenosis score (CSS). The sensitivity, specificity, and likelihood ratios (LR) were calculated for individual and combinations of signs. Results: Partially empty sella (specificity 95.3%, p < 0.0001), flattening of the posterior globes (specificity 100%, p < 0.0001), and CSS <4 (specificity 100%, p < 0.0001) were highly specific for IIH. The presence of one sign, or any combination, significantly increased the odds of a diagnosis of IIH (LR+ 18.5 to 46, p < 0.0001). Their absence, however, did not rule out IIH. Conclusions: Brain MRI with venography significantly increased the diagnostic certainty for IIH if there was no evidence of a mass, hydrocephalus, or sinus thrombosis and one of the following signs was present: flattening of the posterior globes, partially empty sella, CSS <4. However, absence of these signs did not exclude a diagnosis of IIH.

Morphometry of the pituitary gland and hypothalamus in long-term survivors of childhood trauma.

Science.gov (United States)

Porto, L; Margerkurth, J; Althaus, J; You, S-J; Zanella, F E; Kieslich, M

2011-11-01

Chronic pituitary dysfunction is increasingly recognized as a sequela of traumatic brain injury (TBI). Our aim was to rule out any late morphometric changes of the pituitary gland and hypothalamus in survivors of TBI during childhood requiring intensive care. We assessed morphometric abnormalities of the sella region and hypothalamus in patients who sustained TBI during childhood. The patients showed no clinical hormonal dysfunction at the acute phase and pituitary hormone levels at the time of our study were within normal limits. From the 18 enrolled patients in the magnetic resonance study, five were removed due to morphological changes or anatomical variations. We studied the MRI of 13 male survivors (mean age 27 years, mean time after trauma 20 years) and compared them to 13 male control subjects who were matched in terms of age (mean age, 26 years), education and ethnicity. Analyses of the pituitary gland and sella on a midsagittal T2- and T1-weighted image were performed. We used voxel-based morphometry (VBM), an unbiased MRI morphometric method to investigate hypothalamic region in this group of patients. There was only a trend towards a reduced pituitary gland width in the patient group compared to controls. However, no significant morphological and morphometric abnormality was seen and VBM showed no hypothalamic grey matter loss. In the absence of hormonal dysfunction, no persisting morphometric changes of the pituitary gland and hypothalamus were seen in survivors of childhood TBI requiring intensive care.

Metastatic pituitary carcinoma in a patient with acromegaly: a case report

Directory of Open Access Journals (Sweden)

Sreenan Seamus

2012-09-01

Full Text Available Abstract Introduction Asymptomatic pituitary abnormalities occur in about 10% of cranial magnetic resonance imaging scans, but metastatic carcinoma of the pituitary gland is rare: 133 cases have been reported. Two thirds secreted either prolactin or adrenocorticotropic hormone, and another 24% were non-secreting. Case presentation A 42-year-old Caucasian man lived for 30 years after the diagnosis of a pituitary tumor whose clinical and biochemical features were those of acromegaly and hypogonadism. Radiotherapy, totaling 7300 rad, was administered to the sella over two courses. Growth hormone levels normalized, but he developed both thyroid and adrenal insufficiency, and replacement therapy was commenced. Fourteen years later, growth hormone levels again became elevated, and bromocriptine was commenced but led to side effects that could not be tolerated. An attempted surgical intervention failed, and octreotide and pergolide were used in succession. Twenty-seven years after the diagnosis, a mass from an excisional biopsy of below the angle of the mandible proved to be metastatic pituitary carcinoma. Immunohistochemical staining was positive for synaptophysin, growth hormone, and prolactin. One year later, an octreotide scan showed uptake at the sella, neck, and spleen. Our patient declined further active oncology treatment. Conclusions Metastatic pituitary carcinoma associated with acromegaly is particularly rare. To the best of our knowledge, this is the eighth such case and is the first report of growth hormone and prolactin present in the metastatic mass.

Orthodontic camouflage versus orthognathic surgery for class III deformity: comparative cephalometric analysis.

Science.gov (United States)

Martinez, P; Bellot-Arcís, C; Llamas, J M; Cibrian, R; Gandia, J L; Paredes-Gallardo, V

2017-04-01

The objective of this study was to compare different cephalometric variables in adult patients with class III malocclusions before and after treatment, in order to determine which variables are indicative of orthodontic camouflage or orthognathic surgery. The cases of 156 adult patients were assessed: 77 treated with orthodontic camouflage and 79 treated with orthodontics and orthognathic surgery. The following cephalometric variables were measured on pre-treatment (T1) and post-treatment (T2) lateral cephalograms: sella-nasion-A-point (SNA), sella-nasion-B-point (SNB), and A-point-nasion-B-point (ANB) angles, Wits appraisal, facial axis angle, mandibular plane angle, upper and lower incisor inclination, and inter-incisal angle. There were statistically significant differences in cephalometric variables before and after treatment between the two groups. The percentage of normal pre-treatment measurements in the camouflage orthodontics group was 30.7%, which worsened slightly to 28.4% post-treatment. However in the group receiving surgery, this was 24.5% pre-treatment, improving to 33.5% after surgery. SNA, SNB, Wits appraisal, lower incisor inclination, and inter-incisal angle showed differences between the two groups before and after treatment. Wits appraisal, lower incisor inclination, and inter-incisal angle were indicative of one or other treatment. Upper and lower incisor decompensation in both groups did not reach ideal values, which impeded complete skeletal correction in 52% of surgical cases. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

CT studies in hyperprolactinemia; Badania KT w hiperprolaktynemii

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Gradzki, J.; Paprzycki, W.; Krzyzagorska, E.; Wasko, R.; Warenik-Szymankiewicz, A. [Akademia Medyczna, Poznan (Poland)

1993-12-31

Computerized tomography studies in 62 patients (55 females and 7 males) with hyperprolactinemia are presented. The female patients had secondary amenorrhea and galactorrhea, whereas the male patients suffered from impotency, gynaecomastia and very rarely galactorrhea. In 39 cases CT revealed a pituitary adenoma (prolactinoma), in 14 cases of them microadenoma, as the cause of hormonal and clinical disturbances. In 21 cases an empty sella with rudimentary pituitary surrounded by cerebrospinal fluid or lack of pituitary mass were found. In one case suprasellar and intrasellar calcifications were present. (author). 17 refs, 4 figs.

CT studies in hyperprolactinemia; Badania KT w hiperprolaktynemii

Energy Technology Data Exchange (ETDEWEB)

Gradzki, J; Paprzycki, W; Krzyzagorska, E; Wasko, R; Warenik-Szymankiewicz, A [Akademia Medyczna, Poznan (Poland)

1994-12-31

Computerized tomography studies in 62 patients (55 females and 7 males) with hyperprolactinemia are presented. The female patients had secondary amenorrhea and galactorrhea, whereas the male patients suffered from impotency, gynaecomastia and very rarely galactorrhea. In 39 cases CT revealed a pituitary adenoma (prolactinoma), in 14 cases of them microadenoma, as the cause of hormonal and clinical disturbances. In 21 cases an empty sella with rudimentary pituitary surrounded by cerebrospinal fluid or lack of pituitary mass were found. In one case suprasellar and intrasellar calcifications were present. (author). 17 refs, 4 figs.

Preoperative CT evaluation on nasal cavity for transsphenoidal approach

International Nuclear Information System (INIS)

Saeki, Naokatsu; Yamaura, Akira; Hoshi, Seiichiro; Sunada, Souichi; Sunami, Kenro

1997-01-01

Preoperative bone CT scans sliced parallel to the surgical plane were evaluated in 32 cases of transsphenoidal surgery. This method predicted patients with narrow nasal cavity, and helped to determine the rhinological maneuvers for providing a wider operative field. In addition, it helps to plan the need and extent of sella floor removal in re-operated cases. There was relatively little difference in the width and length of the nasal cavity between acromegalic and non-acromegalic patients. Hence, bone CT scans are useful in the preoperative evaluation of patients undergoing transsphenoidal surgery. (author)

De novo Craniopharyngioma of the Fourth Ventricle: Case Report and Review of Literature.

Science.gov (United States)

Algahtani, Abdulhadi Y; Algahtani, Hussein A; Jamjoom, Abdulhakim B; Samkari, Alaa M; Marzuk, Yousef I

2018-01-01

Craniopharyngiomas usually involve the sella and suprasellar space. Their occurrence in the posterior fossa without extension to the suprasellar region is uncommon with only 16 cases reported in the literature. We report a case of a primary posterior fossa craniopharyngioma that was managed by complete excision with a good recovery. Our case was unique in that the craniopharyngioma occurred in the fourth ventricle and extended downward to the level of C1, a manifestation that was reported only twice in the past. The literature on the topic is reviewed.

Resection of a Retrochiasmatic Craniopharyngioma by Combined Modified Orbital Craniotomy and Transnasal Endoscopic Techniques.

Science.gov (United States)

Patel, Nirav J; Dunn, Ian

2018-04-01

A 20-year-old patient presented with hydrocephalus but intact vision and hormone function. The MRI showed a large seller, suprasellar and third ventricular mass. We chose a combined approach utilizing the translyvian, lamina terminals route, with a possible interhemispheric approach. But, we also utilized a transnasal endoscopic approach for the tumor that remained below the diaphragma sellae. The patient did well, with complete tumor resection via a staged approach, but did require hormone replacement. The link to the video can be found at: https://youtu.be/yzpfOxzI4cQ .

MR imaging of the craniocervical junction, cranium, and brain in children with achondroplasia

International Nuclear Information System (INIS)

Kao, S.C.; Waziri, M.; Sato, Y.; Smith, W.L.; Yuh, W.T.C.; Franken, E.A. Jr.

1988-01-01

Ten children with achondroplasia underwent MR imaging of the craniocervical junction, cranium and brain. All patients had narrowing of the subarachnoid space at the level of foramen magnum with apparent upward displacement of the brain stem. Hydrocephalus was seen in five patients, bifrontal widening of subarachnoid space in four, skull asymmetry in two, and an empty sella in one. One patient showed abnormal signal in the central gray matter of the cervicomedullary region. MR is a noninvasive modality for the evaluation of cranial, cerebral, and cervicomedullary is achondroplastic children

High dose radiotherapy for pituitary tumours

International Nuclear Information System (INIS)

Mead, K.W.

1981-01-01

The results of treatment of 120 pituitary tumours are presented. Based on this experience operable chromophobe adenomas are now treated with 5,000 rads in 4 weeks and inoperable ones receive an additional central dose to 7,500 rads. Pituitary Cushing's tumours are given 10,000 rads in 5 weeks using small fields and acromegalics 5,000 rads to the whole sella and 7,500 to its lower half. The absence of complications at these dose levels is attributed to the use of small fields and the precise application of treatment

High dose radiotherapy for pituitary tumours

Energy Technology Data Exchange (ETDEWEB)

Mead, K.W. (Queensland Radium Inst., Herston (Australia))

1981-11-01

The results of treatment of 120 pituitary tumours are presented. Based on this experience operable chromophobe adenomas are now treated with 5,000 rads in 4 weeks and inoperable ones receive an additional central dose to 7,500 rads. Pituitary Cushing's tumours are given 10,000 rads in 5 weeks using small fields and acromegalics 5,000 rads to the whole sella and 7,500 to its lower half. The absence of complications at these dose levels is attributed to the use of small fields and the precise application of treatment.

Comparisons of chewing rhythm, craniomandibular morphology, body mass and height between mothers and their biological daughters.

Science.gov (United States)

Cho, Catherine; Louie, Ke'ale; Maawadh, Ahmed; Gerstner, Geoffrey E

2015-11-01

To study and compare the relationships between mean chewing cycle duration, selected cephalometric variables representing mandibular length, face height, etc., measured in women and in their teenage or young-adult biological daughters. Daughters were recruited from local high schools and the University of Michigan School of Dentistry. Selection criteria included healthy females with full dentition, 1st molar occlusion, no active orthodontics, no medical conditions nor medication use that could interfere with normal masticatory motor function. Mothers had to be biologically related to their daughters. All data were obtained in the School of Dentistry. Measurements obtained from lateral cephalograms included: two "jaw length" measures, condylion-gnathion and gonion-gnathion, and four measures of facial profile including lower anterior face height, and angles sella-nasion-A point (SNA), sella-nasion-B point (SNB) and A point-nasion-B point (ANB). Mean cycle duration was calculated from 60 continuous chewing cycles, where a cycle was defined as the time between two successive maximum jaw openings in the vertical dimension. Other variables included subject height and weight. Linear and logistic regression analyses were used to evaluate the mother-daughter relationships and to study the relationships between cephalometric variables and chewing cycle duration. Height, weight, Co-Gn and Go-Gn were significantly correlated between mother-daughter pairs; however, mean cycle duration was not (r(2)=0.015). Mean cycle duration was positively correlated with ANB and height in mothers, but negatively correlated with Co-Gn in daughters. Chewing rate is not correlated between mothers and daughters in humans. Copyright © 2015 Elsevier Ltd. All rights reserved.

Three cases of ectopic sphenoid sinus pituitary adenoma.

Science.gov (United States)

Bobeff, Ernest Jan; Wiśniewski, Karol; Papierz, Wielisław; Stefańczyk, Ludomir; Jaskólski, Dariusz Jan

2017-01-01

Introduction: Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke's pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims: To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results: One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions: Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment. .

Pharyngeal airway dimensions in skeletal class II: A cephalometric growth study

International Nuclear Information System (INIS)

Uslu-Akcam, Ozge

2017-01-01

This retrospective study aimed to evaluate the nasopharyngeal and oropharyngeal dimensions of individuals with skeletal class II, division 1 and division 2 patterns during the pre-peak, peak, and post-peak growth periods for comparison with a skeletal class I control group. Totally 124 lateral cephalograms (47 for skeletal class I; 45 for skeletal class II, division 1; and 32 for skeletal class II, division 2) in pre-peak, peak, and post-peak growth periods were selected from the department archives. Thirteen landmarks, 4 angular and 4 linear measurements, and 4 proportional calculations were obtained. The ANOVA and Duncan test were applied to compare the differences among the study groups during the growth periods. Statistically significant differences were found between the skeletal class II, division 2 group and other groups for the gonion-gnathion/sella-nasion angle. The sella-nasion-B-point angle was different among the groups, while the A-point-nasion-B-point angle was significantly different for all 3 groups. The nasopharyngeal airway space showed a statistically significant difference among the groups throughout the growth periods. The interaction among the growth periods and study groups was statistically significant regarding the upper oropharyngeal airway space measurement. The lower oropharyngeal airway space measurement showed a statistically significant difference among the groups, with the smallest dimension observed in the skeletal class II, division 2 group. The naso-oropharyngeal airway dimensions showed a statistically significant difference among the class II, division 1; class II, division 2; and class I groups during different growth periods

Three cases of ectopic sphenoid sinus pituitary adenoma

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Ernest Jan Bobeff

2017-03-01

Full Text Available Introduction : Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke’s pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims : To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results : One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions : Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment.

Thin-plate spline analysis of the cranial base in subjects with Class III malocclusion.

Science.gov (United States)

Singh, G D; McNamara, J A; Lozanoff, S

1997-08-01

The role of the cranial base in the emergence of Class III malocclusion is not fully understood. This study determines deformations that contribute to a Class III cranial base morphology, employing thin-plate spline analysis on lateral cephalographs. A total of 73 children of European-American descent aged between 5 and 11 years of age with Class III malocclusion were compared with an equivalent group of subjects with a normal, untreated, Class I molar occlusion. The cephalographs were traced, checked and subdivided into seven age- and sex-matched groups. Thirteen points on the cranial base were identified and digitized. The datasets were scaled to an equivalent size, and statistical analysis indicated significant differences between average Class I and Class III cranial base morphologies for each group. Thin-plate spline analysis indicated that both affine (uniform) and non-affine transformations contribute toward the total spline for each average cranial base morphology at each age group analysed. For non-affine transformations, Partial warps 10, 8 and 7 had high magnitudes, indicating large-scale deformations affecting Bolton point, basion, pterygo-maxillare, Ricketts' point and articulare. In contrast, high eigenvalues associated with Partial warps 1-3, indicating localized shape changes, were found at tuberculum sellae, sella, and the frontonasomaxillary suture. It is concluded that large spatial-scale deformations affect the occipital complex of the cranial base and sphenoidal region, in combination with localized distortions at the frontonasal suture. These deformations may contribute to reduced orthocephalization or deficient flattening of the cranial base antero-posteriorly that, in turn, leads to the formation of a Class III malocclusion.

Diagnosis of tumors of the pituitary region by two-plane CT scans

International Nuclear Information System (INIS)

Murata, Minoru; Inoue, Hiroshi; Misumi, Shuzo; Shimizu, Tsuneo; Tamura, Masaru

1981-01-01

Thirty five cases of tumors in the pituitary region were analysed by two-plane CT (ordinary sections and reverse sections) in order to obtain a more accurate image of the tumor and thus establish an appropriate indication for the subnasal transsphenoidal approach. The tumors of pituitary region were classified into six groups (types I-VI) according to their degree of extension and direction of growth. Small tumors such as types I and II were detected more clearly by the reverse section than by the ordinary section. In cases of large tumors (types III-VI) relation of the tumor to the surrounding structures such as the sphenoid sinus, third ventricle, lateral ventricule, middle fossa and brain stem was accurately demonstrated by the reverse section. In the differential diagnosis of tumors in the pituitary regions, tumors showing mixed density or slightly high density and widening of the anteroposterior diameter of the sella in the precontrast reverse section and homogeneous enhancement by infusion were likely to be pituitary adenomas. One third of the pituitary adenomas showed ring-like high density in the post-contrast reverse section. Calcification was not seen in the pituitary adenomas by CT scans. All craniopharyngiomas belonged to types III-VI. Craniopharyngiomas showed high and/or low density, and various degrees of calcification in plain CT scans. Ring-like high density was seen in two thirds of the craniopharyngiomas. About one third of the craniopharyngiomas showed widening of the antero-posterior diameter of the sella. (J.P.N.)

Do craniopharyngioma molecular signatures correlate with clinical characteristics?

Science.gov (United States)

Omay, Sacit Bulent; Chen, Yu-Ning; Almeida, Joao Paulo; Ruiz-Treviño, Armando Saul; Boockvar, John A; Stieg, Philip E; Greenfield, Jeffrey P; Souweidane, Mark M; Kacker, Ashutosh; Pisapia, David J; Anand, Vijay K; Schwartz, Theodore H

2018-05-01

OBJECTIVE Exome sequencing studies have recently demonstrated that papillary craniopharyngiomas (PCPs) and adamantinomatous craniopharyngiomas (ACPs) have distinct genetic origins, each primarily driven by mutually exclusive alterations: either BRAF ( V600E), observed in 95% of PCPs, or CTNNB1, observed in 75%-96% of ACPs. How the presence of these molecular signatures, or their absence, correlates with clinical, radiographic, and outcome variables is unknown. METHODS The pathology records for patients who underwent surgery for craniopharyngiomas between May 2000 and March 2015 at Weill Cornell Medical College were reviewed. Craniopharyngiomas were identified and classified as PCP or ACP. Patients were placed into 1 of 3 groups based on their genomic mutations: BRAF mutation only, CTNNB1 mutation only, and tumors with neither of these mutations detected (not detected [ND]). Demographic, radiological, and clinical variables were collected, and their correlation with each genomic group was tested. RESULTS Histology correlated strongly with mutation group. All BRAF tumors with mutations were PCPs, and all CTNNB1 with mutations and ND tumors were ACPs. Preoperative and postoperative clinical symptoms and radiographic features did not correlate with any mutation group. There was a statistically significant relationship (p = 0.0323) between the age group (pediatric vs adult) and the mutation groups. The ND group tumors were more likely to involve the sella (p = 0.0065). CONCLUSIONS The mutation signature in craniopharyngioma is highly predictive of histology. The subgroup of tumors in which these 2 mutations are not detected is more likely to occur in children, be located in the sella, and be of ACP histology.

Pharyngeal airway dimensions in skeletal class II: A cephalometric growth study

Energy Technology Data Exchange (ETDEWEB)

Uslu-Akcam, Ozge [Clinic of Orthodontics, Ministry of Health, Tepebasi Oral and Dental Health Hospital, Ankara (Turkmenistan)

2017-03-15

This retrospective study aimed to evaluate the nasopharyngeal and oropharyngeal dimensions of individuals with skeletal class II, division 1 and division 2 patterns during the pre-peak, peak, and post-peak growth periods for comparison with a skeletal class I control group. Totally 124 lateral cephalograms (47 for skeletal class I; 45 for skeletal class II, division 1; and 32 for skeletal class II, division 2) in pre-peak, peak, and post-peak growth periods were selected from the department archives. Thirteen landmarks, 4 angular and 4 linear measurements, and 4 proportional calculations were obtained. The ANOVA and Duncan test were applied to compare the differences among the study groups during the growth periods. Statistically significant differences were found between the skeletal class II, division 2 group and other groups for the gonion-gnathion/sella-nasion angle. The sella-nasion-B-point angle was different among the groups, while the A-point-nasion-B-point angle was significantly different for all 3 groups. The nasopharyngeal airway space showed a statistically significant difference among the groups throughout the growth periods. The interaction among the growth periods and study groups was statistically significant regarding the upper oropharyngeal airway space measurement. The lower oropharyngeal airway space measurement showed a statistically significant difference among the groups, with the smallest dimension observed in the skeletal class II, division 2 group. The naso-oropharyngeal airway dimensions showed a statistically significant difference among the class II, division 1; class II, division 2; and class I groups during different growth periods.

MRI appearances of the sphenoid sinus at the late follow-up of trans-sphenoidal surgery for pituitary macroadenoma

International Nuclear Information System (INIS)

Connor, S.E.J.; Deasy, N.P.

2002-01-01

We aimed to demonstrate the appearances of the sphenoid sinus on MRI performed later than 2 years post-t ranssphenoidal surgery (TSS). We retrospectively reviewed 47 patients in whom follow-up MRI scans had been performed at least 2 years post-TSS. We specifically reviewed the clinical and imaging of those patients in whom the sphenoid sinus was filled with signal abnormality or masses were present arising from the sinus roof and classified them as tumour or indeterminate abnormalities on imaging criteria. We documented other clinicoradiological details. Twelve of 47 patients demonstrated sphenoid sinus filling or sinus roof masses and in six of 12 patients it was possible to classify them as tumourous using imaging and clinical criteria. The indeterminate and non-tumourous sphenoid sinus abnormalities most frequently had a T1-weighted signal similar to subsellar tumour and displayed rim enhancement and thus could not be reliably distinguished from tumourous abnormality on the basis of signal or enhancement characteristics. The presence of a well-defined surgical defect in the sella floor was associated with resolution of abnormality on MRI follow-up. We concluded MRI findings of sphenoid sinus filling or sinus roof masses are present in approximately 26% of scans performed longer than 2 years post-TSS. Half of these are of indeterminate origin and follow-up is required to discriminate tumour from non- tumour with certainty. A well-defined surgical defect in the sella floor is, however, suggestive of a non-tumourous abnormality. Copyright (2002) Blackwell Science Pty Ltd

The trunk and extremities

International Nuclear Information System (INIS)

Raval, B.; Yeakley, J.W.; Harris, J.H.

1987-01-01

Together these volumes form an atlas for multiplanar anatomy of the entire body - using modern state-of-the-art computed tomography supplemented with MRI to provide the thorough knowledge of normal anatomy that's fundamental to recognizing pathological alteration. Each volume can stand alone, and each presents the material using radiologic images presented side by side with labeled drawings. There's information of the sella, temporal bone, wrist, and foot. Different window settings are used to emphasize bone and soft tissue detail. Each of the CT or MR images in the atlas have been specifically selected by the authors to illustrate particular radiologic anatomy

An unusual intracranial metallic foreign bodies and panhypopituitarism.

Science.gov (United States)

Lakouichmi, Mohammed; Baïzri, Hicham; Mouhsine, Abdelilah; Boukhira, Abderrahmane; Akhaddar, Ali

2014-01-01

A 49 years old man, with a history of aggression at the age of 18 years by a pair of scissors, who consulted for unilateral migraine headaches look straight. Paraclinical explorations concluded that trauma to anterior pituitary by a metallic foreign body from the right nostril to the sella, responsible for panhypopituitarism and sinusitis. The headaches are frequent causes of consultation, often treated symptomatically but rarely explored. The direct trauma to the pituitary gland, by a metallic foreign body, is exceptional. We report the case of neglected panhypopituitarism, discovered 31 years after injury with a pair of scissors.

Radiologic study of basal cell nevus syndrome

Energy Technology Data Exchange (ETDEWEB)

Park, Tae Won [Dept. of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

1988-11-15

Several cases of jaw cyst-basal cell nevus-bifid rib syndrome are presented. This syndrome consists principally of multiple jaw cysts, basal cell nevi, and bifid ribs but no one component is present in all patients. The purpose of this paper is to review the multiple characteristics of this syndrome and present three cases in a family and additional 4 cases. The many malformations associated with the syndrome have variable expressively. In the cases, multiple jaw cysts, pal mar and plantar pittings, bridging of sella, temporoparietal bossing, hypertelorism, cleft palate, and dystopia canthoru m have been observed.

Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology.

Science.gov (United States)

Hari Kumar, K V S; Dhull, Pawan; Somasekharan, Manoj; Seshadri, K

2012-01-01

Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr's disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty.

Medical Therapy for Cushing's Syndrome in the Twenty-first Century.

Science.gov (United States)

Tritos, Nicholas A; Biller, Beverly M K

2018-06-01

Medical therapy has a useful adjunctive role in many patients with Cushing's syndrome. Patients with pituitary corticotroph adenomas who have received radiation therapy to the sella require medical therapy until the effects of radiation therapy occur. In addition, patients with Cushing's syndrome who cannot undergo surgery promptly, including those who are acutely ill and cannot safely undergo tumor resection, may benefit from medical therapy as a bridge to surgery. Other possible candidates for medical therapy are those with unresectable tumors or those whose tumor location remains unknown despite adequate diagnostic evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.

Radiologic study of basal cell nevus syndrome

International Nuclear Information System (INIS)

Park, Tae Won

1988-01-01

Several cases of jaw cyst-basal cell nevus-bifid rib syndrome are presented. This syndrome consists principally of multiple jaw cysts, basal cell nevi, and bifid ribs but no one component is present in all patients. The purpose of this paper is to review the multiple characteristics of this syndrome and present three cases in a family and additional 4 cases. The many malformations associated with the syndrome have variable expressively. In the cases, multiple jaw cysts, pal mar and plantar pittings, bridging of sella, temporoparietal bossing, hypertelorism, cleft palate, and dystopia canthoru m have been observed.

Head, neck, and spine

International Nuclear Information System (INIS)

Raval, B.; Yeakley, J.W.; Harris, J.H.

1987-01-01

Together these volumes form an atlas for multiplanar anatomy of the entire body - using modern computed tomography supplemented with MRI to provide the thorough knowledge of normal anatomy that's fundamental to recognizing pathological alteration. Each volume can stand alone, and each presents the material using radiologic images presented side by side with labeled drawings. There's information of the sella, temporal bone, wrist, and foot. Different window settings are used to emphasize bone and soft tissue detail. Each of the CT or MR images in the atlas have been specifically selected by the authors to illustrate particular radiologic anatomy

Anatomic comparison of the endonasal and transpetrosal approaches for interpeduncular fossa access.

Science.gov (United States)

Oyama, Kenichi; Prevedello, Daniel M; Ditzel Filho, Leo F S; Muto, Jun; Gun, Ramazan; Kerr, Edward E; Otto, Bradley A; Carrau, Ricardo L

2014-01-01

The interpeduncular cistern, including the retrochiasmatic area, is one of the most challenging regions to approach surgically. Various conventional approaches to this region have been described; however, only the endoscopic endonasal approach via the dorsum sellae and the transpetrosal approach provide ideal exposure with a caudal-cranial view. The authors compared these 2 approaches to clarify their limitations and intrinsic advantages for access to the interpeduncular cistern. Four fresh cadaver heads were studied. An endoscopic endonasal approach via the dorsum sellae with pituitary transposition was performed to expose the interpeduncular cistern. A transpetrosal approach was performed bilaterally, combining a retrolabyrinthine presigmoid and a subtemporal transtentorium approach. Water balloons were used to simulate space-occupying lesions. "Water balloon tumors" (WBTs), inflated to 2 different volumes (0.5 and 1.0 ml), were placed in the interpeduncular cistern to compare visualization using the 2 approaches. The distances between cranial nerve (CN) III and the posterior communicating artery (PCoA) and between CN III and the edge of the tentorium were measured through a transpetrosal approach to determine the width of surgical corridors using 0- to 6-ml WBTs in the interpeduncular cistern (n = 8). Both approaches provided adequate exposure of the interpeduncular cistern. The endoscopic endonasal approach yielded a good visualization of both CN III and the PCoA when a WBT was in the interpeduncular cistern. Visualization of the contralateral anatomical structures was impaired in the transpetrosal approach. The surgical corridor to the interpeduncular cistern via the transpetrosal approach was narrow when the WBT volume was small, but its width increased as the WBT volume increased. There was a statistically significant increase in the maximum distance between CN III and the PCoA (p = 0.047) and between CN III and the tentorium (p = 0.029) when the WBT volume

Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation.

Science.gov (United States)

Ismail, Mostafa; Fares, Abd Alla; Abdelhak, Balegh; D'Haens, Jean; Michel, Olaf

2016-01-01

Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A - with no intrasellar packing, Group B - with haemostatic materials packing, and Group C - with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no

Analysis of petrous apex meningocele associated with meningioma. Is there any relation with chronic intracranial hypertension?

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Yang, Wan-Qun; Huang, Biao; Liang, Chang-Hong [Southern Medical University, The Second School of Clinical Medicine, Guangzhou (China); Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong (China); Feng, Jie-Ying [Nanhai Hospital Affiliated Southern Medical University, Department of Radiology, Foshan, Guangdong (China); Liu, Hong-Jun [Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong (China)

2018-02-15

Petrous apex meningocele (PAM) is an uncommon cystic lesion involving the petrous apex. The underlying cause of PAM may be related to chronic elevated intracranial pressure. The aim of the study was to explore the relationship between PAM and meningioma and between PAM and other intracranial hypertension findings. Two hundred seventy-eight consecutive patients with meningiomas were retrospectively studied. Fifty age- and gender-matched controls were also enrolled in this study. The incidence of PAM, empty sella, tortuosity of the optic nerve, and hydrops of optic nerve sheath was evaluated. The maximum width, area, volume of each PAM, or Meckel's cave and volume of meningioma were measured in controls and patients, separately. One hundred fifty-nine (57.19%) patients were detected with coexistent PAMs. One hundred twenty-five patients had bilateral PAMs, 34 had unilateral lesions, and the remaining 119 did not have PAM. Two subjects (4/50) had unilateral PAMs in normal controls. The maximum width, area, volume of PAM, or Meckel's cave were significantly larger in the patients with bilateral PAM group than those in the unilateral PAM group, in the group without PAM, and those in control group (p = 0.000). The volume of meningioma was positively correlated with the PAM volume (r = 0.48). There was a positive correlation for the incidence between PAM and (1) empty sella (r = 0.901) and (2) tortuosity of the optic nerves and hydrops of the optic sheath (r = 0.825). Coexistence of PAMs with meningiomas is not rare in incidence, and it suggests a potential role for chronically elevated intracranial pressure and disturbance of CSF circulation in their pathophysiology. (orig.)

Metrizamide cisternography and metrizamide CT cisternography in suprasellar masses

International Nuclear Information System (INIS)

Uchino, Akira

1985-01-01

Ninety patients with suprasellar masses were evaluated by metrizamide cisternography (MC) with or without metrizamide CT cisternography (MCTC). Included were 54 cases with pituitary tumors, 12 with meningiomas arising from the tuberculum sellae, 10 with craniopharyngiomas, and 14 with other rare suprasellar masses. The author established a ''Height x Length Index (HLI)'' as a parameter of size of suprasellar masses on MC, in the mid sagittal plane. Non-functioning pituitary adenomas were larger than hormoneproducing pituitary adenomas. Most meningiomas were of moderate size, and most craniopharyngiomas were larger than other suprasellar masses. Some of the large masses were poorly visualized on MC; however, nearly all masses were well visualized on MCTC. Pituitary tumors and craniopharyngiomas had smooth surfaces, but, the surfaces of meningiomas were rough. Eleven per cent of pituitary tumors, 25 % of meningiomas, and 50 % of craniopharyngiomas were lobulated and were relatively large. Most pituitary tumors were hemispherical or spherical; meningiomas were relatively flat; and craniopharyngiomas were relatively tall. The centers of the pituitary tumors were just above the diaphragma sellae. The centers of meningiomas were located anterior to and the centers of craniopharyngiomas were slightly posterior to the centers of pituitary tumors. The above characteristics facilitated the differential diagnosis of pituitary tumors, meningiomas, and craniopharyngiomas using MC or MCTC. However, a Rathke's cleft cyst and a granuloma mimicked small pituitary tumors. Another Rathke's cleft cyst and granuloma simulated craniopharyngiomas. Chordomas and a mucocele of the sphenoid sinus mimicked pituitary tumors having inferior extensions. It was concluded that MC with or without MCTC is useful not only for detecting, but also for differentiating suprasellar masses. When a mass is poorly visualized on MC, MCTC is indicated. (author)

Delayed radiation necrosis in the optochiasmatic region

International Nuclear Information System (INIS)

Andoh, Takashi; Yokoyama, Kazutoshi; Kumagai, Morio

1984-01-01

Two cases with delayed radiation necrosis of the chiasmatic region following irradiation of the hypophysis for treatment of Cushing's disease were presented. Case 1 was a 36-year-old female who had reduction of visual acuity and bitemporal hemianopsia 2 years after 60 Co-irradiation therapy (total 8000 rads) for Cushing's disease. CT scans showed low density in the pituitary fossa and irregular contrast-enhanced suprasellar mass, and metrizamide CT cisternography revealed the pituitary fossa filled with contrast medium. From those findings, secondary empty sella syndrome was suspicious. Case 2 was a 35-year-old male who had progressive visual disturbance 3 years after 60 Co-irradiation therapy (total 9050 rads) for Cushing's disease. The right visual acuity was 0.05 and the left one was 0.1. Examination of visual field showed left homonymous hemianopsia. CT scans showed the contrast enhanced suprasellar mass extending to the right anterior thalamic region, and metrizamide CT cisternography detected secondary empty sella as same as that of Case 1. Authors reviewed and analyzed literatures of delayed radiation necrosis. The incidence of this condition was 4% to 9% and onset of the symptoms occured approximately 2 years after irradiation to hypophysis. Administration of steroid hormone and surgical treatment for the radiation necrosis involving the chiasmatic region were almost ineffective and also the prognosis of radionecrotic lesions involving the hypothalamus was very poor. Therefore, radiotherapy for hypophyseal region must be carried out by means of a rotation or arching technique in order to avoid this condition and further total dosage and its fractionation in radiation therapy should not exceed 6000 rads and 200 rads a day. (J.P.N.)

Analysis of petrous apex meningocele associated with meningioma. Is there any relation with chronic intracranial hypertension?

International Nuclear Information System (INIS)

Yang, Wan-Qun; Huang, Biao; Liang, Chang-Hong; Feng, Jie-Ying; Liu, Hong-Jun

2018-01-01

Petrous apex meningocele (PAM) is an uncommon cystic lesion involving the petrous apex. The underlying cause of PAM may be related to chronic elevated intracranial pressure. The aim of the study was to explore the relationship between PAM and meningioma and between PAM and other intracranial hypertension findings. Two hundred seventy-eight consecutive patients with meningiomas were retrospectively studied. Fifty age- and gender-matched controls were also enrolled in this study. The incidence of PAM, empty sella, tortuosity of the optic nerve, and hydrops of optic nerve sheath was evaluated. The maximum width, area, volume of each PAM, or Meckel's cave and volume of meningioma were measured in controls and patients, separately. One hundred fifty-nine (57.19%) patients were detected with coexistent PAMs. One hundred twenty-five patients had bilateral PAMs, 34 had unilateral lesions, and the remaining 119 did not have PAM. Two subjects (4/50) had unilateral PAMs in normal controls. The maximum width, area, volume of PAM, or Meckel's cave were significantly larger in the patients with bilateral PAM group than those in the unilateral PAM group, in the group without PAM, and those in control group (p = 0.000). The volume of meningioma was positively correlated with the PAM volume (r = 0.48). There was a positive correlation for the incidence between PAM and (1) empty sella (r = 0.901) and (2) tortuosity of the optic nerves and hydrops of the optic sheath (r = 0.825). Coexistence of PAMs with meningiomas is not rare in incidence, and it suggests a potential role for chronically elevated intracranial pressure and disturbance of CSF circulation in their pathophysiology. (orig.)

Symptomatic hypothalamic-pituitary dysfunction in nasopharyngeal carcinoma patients following radiation therapy: a retrospective study

International Nuclear Information System (INIS)

Lam, K.S.; Ho, J.H.; Lee, A.W.; Tse, V.K.; Chan, P.K.; Wang, C.; Ma, J.T.; Yeung, R.T.

1987-01-01

Endocrine assessment was performed in 32 relapse-free southern Chinese patients 5-17 years following radiation therapy (RT) alone for early nasopharyngeal carcinoma (NPC). Initial screening was done using questionnaires emphasizing impaired sexual function and menstrual disturbance plus measurement of serum levels of thyroxine, free thyroxine index, thyrotropic hormone, prolactin, and additionally testosterone for males only. Those showing abnormalities were subjected to detailed pituitary function tests. Hypothalamic-pituitary dysfunction was found in 7 female patients and only 1 male patient. A delayed TSH response to thyrotropin releasing hormone suggesting a hypothalamic disorder was seen in 6 of the affected female patients, and hyperprolactinaemia in also 6. None of the patients had evidence of diabetes insipidus. Hypopituitarism became symptomatic 2-5 years after RT with a mean latent interval of 3.8 years. A practical protocol for regular endocrine assessment for NPC patients after RT has been proposed. Multiple linear regression analysis of the radiotherapeutic data from the 11 female patients indicates that the likelihood of late occurrence of symptomatic hypothalamic-pituitary dysfunction following RT is dependent on the TDF of the target dose to the nasopharyngeal region and the height of the upper margin of the opposed lateral facial fields above the diaphragma sellae (coefficient of multiple correlation = 0.9025). Except when the sphenoid sinus or the middle cranial fossa is involved, it is advisable to set the height of the upper margin of the lateral facial field at a level no higher than the diaphragma sellae. The hypothalamus and possibly the pituitary stalk as well may sustain permanent damage by doses of radiation within the conventional radiotherapeutic range for carcinomas

Búsqueda de trastornos endocrinos en pacientes con falla ovárica prematura Search for endocrine disorders in patients with premature ovarian failure

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Jorge Sell Lluveras

2001-12-01

, glycaemia, total calcium, phosphates in serum and urine of 24 hours were measured. They also underwent suprarenal stimulation test with corticotrophin (ACTH. Simple X-rays of the sella turcica and CAT of the hypophysis were indicated, too. Euthyroid goiter was confirmed in 13 of the 62 patients (20.9 % and some type of thyroid disorder was found in 18 of them (29 %. In 36 % of the individuals that underwent the stimulation test with ACTH, the cortisol response was null or diminished, though no clinical manifestations of hormone deficit were observed. There were no alterations of fasting glycaemia, calcium, or phosphates. A hypophysis microadenoma was detected in 4 of the 62 cases (6.4 %. To conclude, the results showed that it is not common to find alterations of fasting glycaemia or of the metabolism of calcium and phosphorus among women with POF. As the thyroid and adrenal disorders are usual, their routine screening is recommended in these patients. The frequency of hypophysis microadenomas suggests that it should be searched in every woman with POF.

68Ga DOTATATE PET/CT of Synchronous Meningioma and Prolactinoma.

Science.gov (United States)

Basu, Sandip; Ranade, Rohit; Hazarika, Suman

2016-03-01

Ga DOTATATE PET/CT in noninvasive characterization of synchronous pituitary neoplasm and meningioma in a 38-year-old man is illustrated. The patient presented with an MRI-detected lobulated enhancing sellar-suprasellar mass with erosion of bony sella measuring 4.5 × 3.5 × 3.4 cm (with differential diagnosis with germ cell tumor) and a right parafalcine mass (2.7 × 2.6 cm) suggesting meningioma. Ga DOTATATE PET/CT demonstrated intense uptake in both lesions, suggesting the sellar mass to be pituitary macroadenoma. The finding of high serum prolactin and normal LH, FSH, cortisol, and testosterone levels suggested diagnosis of prolactinoma, and the patient was started on cabergoline.

Combined pituitary hormone deficiency in a girl with 48, XXXX and Rathke's cleft cyst.

Science.gov (United States)

Uppal, Surabhi; Jee, Youn Hee; Lightbourne, Marissa; Han, Joan C; Stratakis, Constantine A

2017-01-01

Tetrasomy X is a rare chromosomal aneuploidy seen in girls, associated with facial dysmorphism, premature ovarian insufficiency and intellectual disability. A Rathke's cleft cyst (RCC) is a remnant of Rathke's pouch which may cause multiple pituitary hormone deficiencies by exerting pressure on the pituitary gland in the sella. The patient was diagnosed with tetrasomy X by karyotyping during infancy. Brain MRI and multiple endocrine stimulation tests revealed RCC and combined pituitary hormone deficiency (growth hormone deficiency, secondary adrenal insufficiency and central hypothyroidism) likely due to RCC. We report the first case in the literature of a girl with 48, XXXX and combined pituitary hormone deficiency due to Rathke's cyst.

Internal maxillary distraction with a new bimalar device.

Science.gov (United States)

Kahn, David M; Broujerdi, Joseph; Schendel, Stephen A

2008-04-01

Distraction osteogenesis of the Le Fort I segment is advocated for patients who require significant advancement of the maxilla or who have a soft tissue envelope compromised by scar tissue. We present a technique for maxillary distraction using an interconnecting intraoral device anchored to the malar prominences above the osteotomy and either the maxilla and/or the dentition below the level of the osteotomy. Ten patients with nonsyndromic cleft lip and palate, mean age of 18, underwent Le Fort I maxillary distraction osteogenesis for management of maxillary hypoplasia. A Le Fort I osteotomy is performed and a Spectrum Intraoral Midface Multi-Vector Distractor (OsteoMed, Addison, TX) is placed leaving a 1 mm to 2 mm distraction gap. After a 2 to 4 day latency period, distraction begins at a rate of 1 mm a day. Once the desired occlusion is achieved the device is left in place for a minimum of 2 months for consolidation. Preoperative Sella-Nasion-A point measurements from lateral cephalograms averaged 74 degrees (range, 70-76 degrees). Postoperative Sella-Nasion-A point averaged 81 degrees (range, 75-89 degrees). Preoperative overjet averaged -7.4 mm (range, -3 to -13 mm). Postoperative overjet averaged 2.6 mm (range, 1-3 mm). Average distraction was 9 mm (range, 6-16 mm). The average vertical movement was 7.2 mm in an inferior direction (range, 0-15 mm). The results remained stable at a follow-up of 30 months. We report on distraction of the Le Fort I segment using an internal device. The device design allows the forces of distraction to be shared across a larger surface area delivering a uniform and reliable vector of distraction with increased stability.

Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation

Directory of Open Access Journals (Sweden)

Ismail, Mostafa

2016-06-01

Full Text Available Objectives: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing.Methods: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A – with no intrasellar packing, Group B – with haemostatic materials packing, and Group C – with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome.Results: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. Conclusions: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages

The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension.

Science.gov (United States)

Watane, Gaurav Vishwasrao; Patel, Bhumi; Brown, Derek; Taheri, M Reza

The aim of this article was to study the significance of arachnoid granulations (AGs) in patients with idiopathic intracranial hypertension (IIH). In an institutional review board-approved retrospective chart review study, 79 patients with clinical diagnosis of idiopathic increased intracranial pressure were compared with 63 patients with a diagnosis of multiple sclerosis. Inclusion criteria also included available magnetic resonance imaging (MRI) of the brain, older than 18 years, and female sex. Patients with elevated intracranial pressure due to other causes were excluded. The electronic medical records were mined for presence of the following: body mass index, age, headache, vision changes, tinnitus, and vertigo. The MRI of the brain was reviewed for the presence of the following features: empty sella, prominent cerebrospinal fluid space in the optic sheaths, tortuosity of the optic nerves and enlarged Meckel cave. In addition, the number, size, and location of AGs associated with major venous drainage sinuses were documented in all patients. Using statistical analysis, association between various imaging and clinical signs were evaluated. The association between AG and various imaging and clinical signs were evaluated. The percentage of patients with AG were significantly higher in patients with IIH. Patients with IIH tended to have 0 to 3 AG. The most common imaging findings observed in MRI of the brain of patients with IIH were empty sella and prominent cerebrospinal fluid space in the optic sheaths. The prevalence of these MRI findings in patients with IIH was inversely proportional to the number of AG. A similar inverse trend was also noted with the opening pressure of patients with IIH and number of AG. The study establishes that there is a relationship between presence of AG and IIH. Arachnoid granulation seems to act in a compensatory mechanism in patients with IIH.

Visual disability rates in a ten-year cohort of patients with anterior visual pathway meningiomas.

Science.gov (United States)

Bor-Shavit, Elite; Hammel, Naama; Nahum, Yoav; Rappaport, Zvi Harry; Stiebel-Kalish, Hadas

2015-01-01

To examine the visual outcome of anterior visual pathway meningioma (AVPM) patients followed for at least one year. Data were collected on demographics, clinical course and management. Visual disability was classified at the first and last examination as follows: I--no visual disability; II--mild visual defect in one eye; III--mild visual defect in both eyes; IV--loss of driver's license; V--legally blind. Eight-one AVPM patients had their tumor originate in the clinoid process in 23 (28%), sphenoid-wing area in 18 (22%), cavernous sinus in 15 (19%), tuberculum sellae in 8 (10%), and mixed in 17 (21%). On last examination, 46 patients (57%) had good visual acuity in one or both eyes (Class I or II) and 17 (21%) were mildly affected in both eyes. The rate of Class IV disability was 16%, and Class V disability was 6%. Attention needs to be addressed to the considerable proportion of patients with AVPM (22% in this study) who may lose their driver's license or become legally blind. Occupational therapists should play an important role in the multidisciplinary management of those patients to help them adapt to their new physical and social situation. Anterior visual pathway meningiomas (AVPMs) are commonly not life-threatening but they can lead to profound visual disability, especially when the tumor originates in the tuberculum sellae and cavernous sinus. Particular attention should be paid to visual acuity and visual field deficits, as these can profoundly affect the patient's quality of life including ability to drive and activities of daily living. The interdisciplinary management of patients with AVPM should include the neurosurgeon, neuro-ophthalmologist and occupational therapist. Also, early intervention by the occupational therapist can help patients adapt to their current physical and social situation and return to everyday tasks more rapidly.

MRI features of growth hormone deficiency in children with short stature caused by pituitary lesions.

Science.gov (United States)

Xu, Chao; Zhang, Xinxian; Dong, Lina; Zhu, Bin; Xin, Tao

2017-06-01

We verified the advantages of using magnetic resonance imaging (MRI) for improving the diagnostic quality of growth hormone deficiency (GHD) in children with short stature caused by pituitary lesions. Clinical data obtained from 577 GHD patients with short stature caused by pituitary lesions were retrospectively analyzed. There were 354 cases (61.3%) with anterior pituitary dysplasia; 45 cases (7.8%) of pituitary stalk interruption syndrome (PSIS); 15 cases (2.6%) of pituitary hyperplasia due to primary hypothyroidism; 38 cases (6.6%) of Rathke cleft cyst; 68 cases (11.8%) of empty sella syndrome; 16 cases (2.8%) of pituitary invasion from Langerhans cell histiocytosis; 2 cases (0.3%) of sellar regional arachnoid cyst and 39 cases (6.8%) of craniopharyngioma. MRI results showed that the height of anterior pituitary in patients was less than normal. Location, size and signals of posterior pituitary and pituitary stalk were normal in anterior pituitary dysplasia. In all cases pituitary hyperplasia was caused by hypothyroidism. MRI results showed that anterior pituitary was enlarged, and we detected upward apophysis and obvious homogeneous enhancement. There were no pituitary stalk interruption and abnormal signal. We also observed that after hormone replacement therapy the size of pituitary gland was reduced. Anterior pituitary atrophy was observed in Rathke cleft cyst, empty sella syndrome, sellar regional arachnoid cyst and craniopharyngioma. The microstructure of hypophysis and sellar region was studied with MRI. We detected pituitary lesions, and the characteristics of various pituitary diseases of GHD in children with short stature. It was concluded that in children with GHD caused by pituitary lesions, MRI was an excellent method for early diagnosis. This method offers clinical practicability and we believe it can be used for differential diagnosis and to monitor the therapeutic effects.

Trans-sphenoidal excision of craniopharyngiomas.

Directory of Open Access Journals (Sweden)

Nagpal R

1991-04-01

Full Text Available Craniopharyngiomas have been by and large excised by the transcranial route. Since 1982, 11 patients have been operated by the traus-sphensidal route in the department. The clinical features with which they were presented, diagnostic investigations, details of surgical procedures and follow-up analysis is being presented here. A retrospective study of radiological investigation was done to determine the features that help decide the choice of surgical approach to these lesions. Only lesions that were primarily intrasellar, cystic and those that expanded the sella could be treated by the trans-sphenoidal route. Associated suprasellar extensions could also be removed. Predominantly calcified or firm, fleshy tumours lent themselves poorly to removal by the trans-sphenoidal route.

MR imaging of central diabetes insipidus: a pictorial essay

International Nuclear Information System (INIS)

Shin, Ji Hoon; Lee, Ho Kyu; Choi, Choong Gon; Suh, Dae Chul; Kim, Chang Jin; Hong, Sung Kwan; Na, Dong Gyu

2001-01-01

Central diabetes insipidus (DI) can be the outcome of a number of diseases that affect the hypothalamic-neurohypophyseal axis. The causes of the condition can be classified as traumatic, inflammatory, or neoplastic. Traumatic causes include postoperative sella or transection of the pituitary stalk, while infectious or inflammatory causes include meningitis, lymphocytic hypophysitis, and granulomatous inflammations such as sarcoidosis and Wegener's granulomatosis. Various neoplastic conditions such as germinoma, Langerhans cell histiocytosis, metastasis, leukemic infiltration, lymphoma, teratoma, pituitary adenoma, craniopharyngioma, Rathke cleft cyst, hypothalamic glioma, and meningioma are also causes of central DI. In affected patients, careful analysis of these MR imaging features and correlation with the clinical manifestations can allow a more specific diagnosis, which is essential for treatment

Magnetic resonance imaging in patients with panhypopituitarism

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Pozzi Mucelli, R.S. [Ist. di Radiologia, Univ. di Trieste, Ospedale di Cattinara (Italy); Frezza, F. [Ist. di Radiologia, Univ. di Trieste, Ospedale di Cattinara (Italy); Magnaldi, S. [Ist. di Radiologia, Univ. di Trieste, Ospedale di Cattinara (Italy); Proto, G. [Servizio di Endocrinologia, Ospedale Civile di Udine (Italy)

1992-02-01

Primary panhypopituitarism consists of functional deficiency of the anterior pituitary lobe, which appears during infancy or adolescence. The magnetic resonance findings in 10 patients with a history of primary hypopituitarism are presented. The findings include: reduced pituitary size in all cases; partially (8 cases) or totally (2 cases) empty sella; thin (4 cases), partially visible (3 cases) or absent (2 cases) pituitary stalk; absence of the posterior lobe in 9 cases; bright spot corresponding to an ectopic posterior lobe in 8 cases. These findings are similar to those already reported in pituitary dwarfism and may help understanding of the pathogenesis of the disease, which seems to be related to a pituitary stalk lesion. (orig.)

Magnetic resonance imaging in patients with panhypopituitarism

International Nuclear Information System (INIS)

Pozzi Mucelli, R.S.; Frezza, F.; Magnaldi, S.; Proto, G.

1992-01-01

Primary panhypopituitarism consists of functional deficiency of the anterior pituitary lobe, which appears during infancy or adolescence. The magnetic resonance findings in 10 patients with a history of primary hypopituitarism are presented. The findings include: reduced pituitary size in all cases; partially (8 cases) or totally (2 cases) empty sella; thin (4 cases), partially visible (3 cases) or absent (2 cases) pituitary stalk; absence of the posterior lobe in 9 cases; bright spot corresponding to an ectopic posterior lobe in 8 cases. These findings are similar to those already reported in pituitary dwarfism and may help understanding of the pathogenesis of the disease, which seems to be related to a pituitary stalk lesion. (orig.)

Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region

Science.gov (United States)

2013-01-01

Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region. PMID:23919255

Folate receptor overexpression can be visualized in real time during pituitary adenoma endoscopic transsphenoidal surgery with near-infrared imaging.

Science.gov (United States)

Lee, John Y K; Cho, Steve S; Zeh, Ryan; Pierce, John T; Martinez-Lage, Maria; Adappa, Nithin D; Palmer, James N; Newman, Jason G; Learned, Kim O; White, Caitlin; Kharlip, Julia; Snyder, Peter; Low, Philip S; Singhal, Sunil; Grady, M Sean

2017-08-25

OBJECTIVE Pituitary adenomas account for approximately 10% of intracranial tumors and have an estimated prevalence of 15%-20% in the general US population. Resection is the primary treatment for pituitary adenomas, and the transsphenoidal approach remains the most common. The greatest challenge with pituitary adenomas is that 20% of patients develop tumor recurrence. Current approaches to reduce recurrence, such as intraoperative MRI, are costly, associated with high false-positive rates, and not recommended. Pituitary adenomas are known to overexpress folate receptor alpha (FRα), and it was hypothesized that OTL38, a folate analog conjugated to a near-infrared (NIR) fluorescent dye, could provide real-time intraoperative visual contrast of the tumor versus the surrounding nonneoplastic tissues. The preliminary results of this novel clinical trial are presented. METHODS Nineteen adult patients who presented with pituitary adenoma were enrolled. Patients were infused with OTL38 2-4 hours prior to surgery. A 4-mm endoscope with both visible and NIR light capabilities was used to visualize the pituitary adenoma and its margins in real time during surgery. The signal-to-background ratio (SBR) was recorded for each tumor and surrounding tissues at various endoscope-to-sella distances. Immunohistochemical analysis was performed to assess the FRα expression levels in all specimens and classify patients as having either high or low FRα expression. RESULTS Data from 15 patients (4 with null cell adenomas, 1 clinically silent gonadotroph, 1 totally silent somatotroph, 5 with a corticotroph, 3 with somatotrophs, and 1 somatocorticotroph) were analyzed in this preliminary analysis. Four patients were excluded for technical considerations. Intraoperative NIR imaging delineated the main tumors in all 15 patients with an average SBR of 1.9 ± 0.70. The FRα expression level of the adenomas and endoscope-to-sella distance had statistically significant impacts on the fluorescent

[The growing skull. Part I. Neurocranium. Statistical considerations (author's transl)].

Science.gov (United States)

Gefferth, K

1976-01-01

Measurements were made on the radiographs of the skull of 540 boys and 496 girls obtained in the years 1951-1968. Distances and angles were established with the Tuberculum sellae as the centre. The subjects ranged in age from the first day of life till late puberty. They were divided into 26 groups comprising smaller periods in earlier life, and increasing with age. Results are presented of measurements of 9 distances and 3 angles exclusively concerning the neurocranium. The neurocranium of the girls is smaller than that of the boys from the first day of life and the difference is growing with age. The angles displayed little sex differences. The greater part of the growth of distance takes place in the earliest period of life.

MR imaging of central diabetes insipidus: a pictorial essay

Energy Technology Data Exchange (ETDEWEB)

Shin, Ji Hoon; Lee, Ho Kyu; Choi, Choong Gon; Suh, Dae Chul; Kim, Chang Jin; Hong, Sung Kwan [Ulsan University College of Medicine, Seoul (Korea, Republic of); Na, Dong Gyu [Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

2001-12-01

Central diabetes insipidus (DI) can be the outcome of a number of diseases that affect the hypothalamic-neurohypophyseal axis. The causes of the condition can be classified as traumatic, inflammatory, or neoplastic. Traumatic causes include postoperative sella or transection of the pituitary stalk, while infectious or inflammatory causes include meningitis, lymphocytic hypophysitis, and granulomatous inflammations such as sarcoidosis and Wegener's granulomatosis. Various neoplastic conditions such as germinoma, Langerhans cell histiocytosis, metastasis, leukemic infiltration, lymphoma, teratoma, pituitary adenoma, craniopharyngioma, Rathke cleft cyst, hypothalamic glioma, and meningioma are also causes of central DI. In affected patients, careful analysis of these MR imaging features and correlation with the clinical manifestations can allow a more specific diagnosis, which is essential for treatment.

Nevoid basal cell carcinoma syndrome with medulloblastoma and meningioma. Case report

International Nuclear Information System (INIS)

Fukushima, Yutaka; Oka, Hidehiro; Utsuki, Satoshi; Iwamoto, Kazuhisa; Fujii, Kiyotaka

2004-01-01

A 35-year-old man presented with a rare case of nevoid basal cell carcinoma syndrome, or Gorlin's syndrome, associated with both medulloblastoma and meningioma, manifesting as visual field constriction due to multiple parasellar tumors. He had undergone resection of a medulloblastoma at the age of 1 year 9 months, followed by adjunctive irradiation with a total dose of 40 Gy. He presented with multiple subcutaneous nodules on his face and neck. Histological examination of biopsy specimens established the diagnosis of nevoid basal cell carcinoma syndrome. Tuberculum sellae meningioma was removed through a craniotomy, and his symptoms improved. Meningioma is known to occur in the field of therapeutic irradiation, so chemotherapy may be a better option for medulloblastoma associated with nevoid basal cell carcinoma syndrome. (author)

Permanent Genetic Resources added to Molecular Ecology Resources database 1 January 2009-30 April 2009.

Science.gov (United States)

Abercrombie, L G; Anderson, C M; Baldwin, B G; Bang, I C; Beldade, R; Bernardi, G; Boubou, A; Branca, A; Bretagnolle, F; Bruford, M W; Buonamici, A; Burnett, R K; Canal, D; Cárdenas, H; Caullet, C; Chen, S Y; Chun, Y J; Cossu, C; Crane, C F; Cros-Arteil, S; Cudney-Bueno, R; Danti, R; Dávila, J A; Della Rocca, G; Dobata, S; Dunkle, L D; Dupas, S; Faure, N; Ferrero, M E; Fumanal, B; Gigot, G; González, I; Goodwin, S B; Groth, D; Hardesty, B D; Hasegawa, E; Hoffman, E A; Hou, M L; Jamsari, A F J; Ji, H J; Johnson, D H; Joseph, L; Justy, F; Kang, E J; Kaufmann, B; Kim, K S; Kim, W J; Koehler, A V; Laitung, B; Latch, P; Liu, Y D; Manjerovic, M B; Martel, E; Metcalfe, S S; Miller, J N; Midgley, J J; Migeon, A; Moore, A J; Moore, W L; Morris, V R F; Navajas, M; Navia, D; Neel, M C; De Nova, P J G; Olivieri, I; Omura, T; Othman, A S; Oudot-Canaff, J; Panthee, D R; Parkinson, C L; Patimah, I; Pérez-Galindo, C A; Pettengill, J B; Pfautsch, S; Piola, F; Potti, J; Poulin, R; Raimondi, P T; Rinehart, T A; Ruzainah, A; Sarver, S K; Scheffler, B E; Schneider, A R R; Silvain, J F; Siti Azizah, M N; Springer, Y P; Stewart, C N; Sun, W; Tiedemann, R; Tsuji, K; Trigiano, R N; Vendramin, G G; Wadl, P A; Wang, L; Wang, X; Watanabe, K; Waterman, J M; Weisser, W W; Westcott, D A; Wiesner, K R; Xu, X F; Yaegashi, S; Yuan, J S

2009-09-01

This article documents the addition of 283 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Agalinis acuta; Ambrosia artemisiifolia; Berula erecta; Casuarius casuarius; Cercospora zeae-maydis; Chorthippus parallelus; Conyza canadensis; Cotesia sesamiae; Epinephelus acanthistius; Ficedula hypoleuca; Grindelia hirsutula; Guadua angustifolia; Leucadendron rubrum; Maritrema novaezealandensis; Meretrix meretrix; Nilaparvata lugens; Oxyeleotris marmoratus; Phoxinus neogaeus; Pristomyrmex punctatus; Pseudobagrus brevicorpus; Seiridium cardinale; Stenopsyche marmorata; Tetranychus evansi and Xerus inauris. These loci were cross-tested on the following species: Agalinis decemloba; Agalinis tenella; Agalinis obtusifolia; Agalinis setacea; Agalinis skinneriana; Cercospora zeina; Cercospora kikuchii; Cercospora sorghi; Mycosphaerella graminicola; Setosphaeria turcica; Magnaporthe oryzae; Cotesia flavipes; Cotesia marginiventris; Grindelia Xpaludosa; Grindelia chiloensis; Grindelia fastigiata; Grindelia lanceolata; Grindelia squarrosa; Leucadendron coniferum; Leucadendron salicifolium; Leucadendron tinctum; Leucadendron meridianum; Laodelphax striatellus; Sogatella furcifera; Phoxinus eos; Phoxinus rigidus; Phoxinus brevispinosus; Phoxinus bicolor; Tetranychus urticae; Tetranychus turkestani; Tetranychus ludeni; Tetranychus neocaledonicus; Tetranychus amicus; Amphitetranychus viennensis; Eotetranychus rubiphilus; Eotetranychus tiliarium; Oligonychus perseae; Panonychus citri; Bryobia rubrioculus; Schizonobia bundi; Petrobia harti; Xerus princeps; Spermophilus tridecemlineatus and Sciurus carolinensis. © 2009 Blackwell Publishing Ltd.

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery.

Science.gov (United States)

Chittiboina, Prashant; Talagala, S Lalith; Merkle, Hellmut; Sarlls, Joelle E; Montgomery, Blake K; Piazza, Martin G; Scott, Gretchen; Ray-Chaudhury, Abhik; Lonser, Russell R; Oldfield, Edward H; Koretsky, Alan P; Butman, John A

2016-12-01

OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing's disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC. The ESC (a double-turn, 12-mm-diameter surface coil made from 1-mm-diameter copper wire) was developed to obtain images in a 1.5-T MR scanner. The ESC was placed (via a standard sublabial TSS approach) on the anterior sella face. Clinical MR scans were obtained using the 8-channel head coil and ESC as the receiver coils. Using the ESC, ultra-high-resolution, 3D, balanced fast field echo (BFFE) and T1-weighted imaging were performed at resolutions of 0.25 × 0.25 × 0.50 mm 3 and 0.15 × 0.15 × 0.30 mm 3 , respectively. RESULTS Region-of-interest analysis indicated a 10-fold increase in the signal-to-noise ratio (SNR) of the pituitary when using the ESC compared with the 8-channel head coil. ESC-related improvements (p anterior pituitary gland surface. High-resolution BFFE MR imaging obtained using ESC revealed a number of anatomical features critical to pituitary surgery that were not visible on 8-channel MR imaging, including the pituitary capsule, the intercavernous sinus, and microcalcifications in the pars intermedia. These ESC imaging findings were confirmed by the pathological correlation with whole-mount pituitary sections. CONCLUSIONS ESC can significantly improve SNR in the sellar region intraoperatively using current 1.5-T MR imaging platforms. Improvement in SNR can provide images of the sella and surrounding structures with unprecedented resolution. Clinical use of this ESC may allow for MR imaging detection of previously occult

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome.

Science.gov (United States)

Koulouri, Olympia; Steuwe, Andrea; Gillett, Daniel; Hoole, Andrew C; Powlson, Andrew S; Donnelly, Neil A; Burnet, Neil G; Antoun, Nagui M; Cheow, Heok; Mannion, Richard J; Pickard, John D; Gurnell, Mark

2015-10-01

We report our experience of functional imaging with (11)C-methionine positron emission tomography-computed tomography (PET-CT) co-registered with 3D gradient echo (spoiled gradient recalled (SPGR)) magnetic resonance imaging (MRI) in the investigation of ACTH-dependent Cushing's syndrome. Twenty patients with i) de novo Cushing's disease (CD, n=10), ii) residual or recurrent hypercortisolism following first pituitary surgery (±radiotherapy; n=8) or iii) ectopic Cushing's syndrome (n=2) were referred to our centre for functional imaging studies between 2010 and 2015. Six of the patients with de novo CD and five of those with persistent/relapsed disease had a suspected abnormality on conventional MRI. All patients underwent (11)C-methionine PET-CT. For pituitary imaging, co-registration of PET-CT images with contemporaneous SPGR MRI (1 mm slice thickness) was performed, followed by detailed mapping of (11)C-methionine uptake across the sella in three planes (coronal, sagittal and axial). This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging. In seven of ten patients with de novo CD, asymmetric (11)C-methionine uptake was observed within the sella, which co-localized with the suspected site of a corticotroph microadenoma visualised on SPGR MRI (and which was subsequently confirmed histologically following successful transsphenoidal surgery (TSS)). Focal (11)C-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region. (11)C-methionine PET-CT can aid the detection of

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Science.gov (United States)

Chittiboina, Prashant; Talagala, S. Lalith; Merkle, Hellmut; Sarlls, Joelle E.; Montgomery, Blake K.; Piazza, Martin G.; Scott, Gretchen; Ray-Chaudhury, Abhik; Lonser, Russell R.; Oldfield, Edward H.; Koretsky, Alan P.; Butman, John A.

2016-01-01

OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing’s disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC. The ESC (a double-turn, 12-mm-diameter surface coil made from 1-mm-diameter copper wire) was developed to obtain images in a 1.5-T MR scanner. The ESC was placed (via a standard sublabial TSS approach) on the anterior sella face. Clinical MR scans were obtained using the 8-channel head coil and ESC as the receiver coils. Using the ESC, ultra–high-resolution, 3D, balanced fast field echo (BFFE) and T1-weighted imaging were performed at resolutions of 0.25 × 0.25 × 0.50 mm3 and 0.15 × 0.15 × 0.30 mm3, respectively. RESULTS Region-of-interest analysis indicated a 10-fold increase in the signal-to-noise ratio (SNR) of the pituitary when using the ESC compared with the 8-channel head coil. ESC-related improvements (p pituitary gland surface. High-resolution BFFE MR imaging obtained using ESC revealed a number of anatomical features critical to pituitary surgery that were not visible on 8-channel MR imaging, including the pituitary capsule, the intercavernous sinus, and microcalcifications in the pars intermedia. These ESC imaging findings were confirmed by the pathological correlation with whole-mount pituitary sections. CONCLUSIONS ESC can significantly improve SNR in the sellar region intraoperatively using current 1.5-T MR imaging platforms. Improvement in SNR can provide images of the sella and surrounding structures with unprecedented resolution. Clinical use of this ESC may allow for MR imaging detection of previously occult pituitary

High resolution computed tomography of the post partum pituitary gland

International Nuclear Information System (INIS)

Hinshaw, D.B.; Hasso, A.N.; Thompson, J.R.; Davidson, B.J.

1984-01-01

Eight volunteer post partum female patients were examined with high resolution computed tomography during the week immediately after delivery. All patients received high dose (40-70 gm) intravenous iodine contrast administration. The scans were examined for pituitary gland height, shape and homogeneity. All of the patients had enlarged glands by the traditional standards (i.e. gland height of 8 mm or greater). The diaphragma sellae in every call bulged upward with a convex domed appearance. The glands were generally inhomogeneous. One gland had a 4 mm focal well defined area of decreased attenuation. Two patients who were studied again months later had glands which had returned to ''normal'' size. The enlarged, upwardly convex pituitary gland appears to be typical and normal for the recently post partum period. (orig.)

Pituitary adenoma in monozigotic twins with Cri du Chat syndome: a rare case report

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Canaz Gokhan

2016-12-01

Full Text Available Pituitary adenomas are rare tumours of pediatric population. In etiology, genetic factors are more common than they are in adults. Because of the rarity of the cases, there are only a few large case studies in the literature. Pituitary tumours in children are often related with syndromes like MEN type 1, Carney Complex and Mc Cune Albright, but there is no case in the literature associated with Cri Du Chat syndrome. Statisticlly, it has been reported that, pediatric tumours occur more often in twins, in the pediatric population. Main treatment for prolactinomas is medical intervention with dopamine agonists, as in adults. Surgery is prefered when the tumour is resistant to medical treatment or shows mass effects around sellae. In that situation, as in adults, both transcranial and transsphenoidal approach is possible.

A case of phace syndrome and acquired hypopituitarism?

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Denzer Friederike

2012-06-01

Full Text Available Abstract Background PHACE is a neurocutaneous syndrome associated with: Posterior fossa brain malformations, large “segmental” facial hemangiomas, arterial cerebrovascular-, cardiovascular-, and eye anomalies. Case vignette We are reporting a girl with PHACE syndrome. The patient had a congenital right-sided facial hemangioma with plaque-morphology. At age 11 years and 2 months she presented with short stature, markedly decreased growth velocity and signs and symptoms suggestive of hypothyroidism. Magnetic Resonance Imaging (MRI of the brain revealed complex structural and cerebrovascular arterial anomalies, including an empty sella. Testing of pituitary function revealed multiple pituitary dysfunctions, including absolute growth hormone deficiency, hypogonadotropic hypogonadism, central hypothyroidism, and secondary adrenal insufficiency. Conclusions This case suggests the necessity to screen all patients with PHACE syndrome and intracranial malformations for pituitary dysfunction at regular intervals.

A comparison of the value of MRI and CT in patients with Nelson syndrome

International Nuclear Information System (INIS)

Kersjes, W.; Allmendinger, S.; Christ, F.; Stiebler, H.; Bockisch, A.; Klingmueller, D.

1992-01-01

The hypophyses of 13 patients with Nelson syndrome following bilateral adrenalectomy were examined by MRI and CT. Diffuse enlargement of the hypophysis was demonstrated in 8 patients by CT and in 9 by MRI. Compared with CT, MRI provides better demonstration of tumour development, such as abnormal convexity of the cranial margin of the hypophysis (MRI 4/13, CT 1/13), displacement of the infundibulum (MRI 4/13, CT 0/13) or optic chiasm (MRI 2/13, CT 0/13). MRI also provides diagnostically important differentiation between scar tissue and recurrence of tumour following hypophysectomy (MRI 1/3, CT 0/3) and more accurate demonstration of infiltration of the cavernous sinus (MRI 4/13, CT 2/13). CT is superior only in showing the floor of the sella. MRI is the method of choice for imaging in cases of Nelson syndrome. (orig.) [de

Investigação neurorradiológica de pacientes com deficiência idiopática de hormônio do crescimento Neuroradiological investigation in patients with idiopathic growth hormone deficiency

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Maria Alice N. Bordallo

2004-06-01

anormalidades observadas à ressonância magnética pode sugerir a presença de deficiência múltipla de hormônio do crescimento.OBJECTIVE: The aim of this study was to analyze the type and frequency of cranial computed tomography and magnetic resonance imaging anomalies in patients with idiopathic growth hormone deficiency (GHD, and also to investigate the possible relationship between neuroradiological images and the presence of isolated GH or multiple pituitary hormone deficiency. METHODS: Magnetic resonance and computed tomography images were obtained for 37 patients with idiopathic growth hormone deficiency (GHD. The patients were divided into two groups: patients with isolated GH (group A and patients with multiple pituitary hormone deficiencies (group B. RESULTS: Computed tomography was normal in 25(68%, and abnormal in 12(32% patients. We observed empty sella in 50%, partially empty sella in 17% and anterior pituitary hypoplasia in 33% patients. MRI studies revealed normal findings in the hypothalamus-pituitary area in 17 (46% and abnormal in 20 (54% patients. We didn't observed differences in the frequency of computed tomography alterations when groups A and B were compared (p = 0.55. With magnetic resonance imaging we observed, empty sella in 10%, partially empty sella in 15% and anterior pituitary hypoplasia in 75% patients. Among those patients whose magnetic resonance images were altered, the posterior lobe of the pituitary gland was identified in an abnormal position in 70%, and the hypophyseal stalk was thin or interrupted in 60%. The patients from group B presented a higher frequency of magnetic resonance imaging anomalies (90% when compared to group A (10%, p = 0.03. There was disagreement between the two methods in 43% of cases, but we didn't observe a difference in the frequency of alterations when computed tomography was compared with magnetic resonance imaging (p = 0.06. CONCLUSIONS: The most frequent defects observed using magnetic resonance imaging are

Semiautomated confocal imaging of fungal pathogenesis on plants: Microscopic analysis of macroscopic specimens.

Science.gov (United States)

Minker, Katharine R; Biedrzycki, Meredith L; Kolagunda, Abhishek; Rhein, Stephen; Perina, Fabiano J; Jacobs, Samuel S; Moore, Michael; Jamann, Tiffany M; Yang, Qin; Nelson, Rebecca; Balint-Kurti, Peter; Kambhamettu, Chandra; Wisser, Randall J; Caplan, Jeffrey L

2018-02-01

The study of phenotypic variation in plant pathogenesis provides fundamental information about the nature of disease resistance. Cellular mechanisms that alter pathogenesis can be elucidated with confocal microscopy; however, systematic phenotyping platforms-from sample processing to image analysis-to investigate this do not exist. We have developed a platform for 3D phenotyping of cellular features underlying variation in disease development by fluorescence-specific resolution of host and pathogen interactions across time (4D). A confocal microscopy phenotyping platform compatible with different maize-fungal pathosystems (fungi: Setosphaeria turcica, Cochliobolus heterostrophus, and Cercospora zeae-maydis) was developed. Protocols and techniques were standardized for sample fixation, optical clearing, species-specific combinatorial fluorescence staining, multisample imaging, and image processing for investigation at the macroscale. The sample preparation methods presented here overcome challenges to fluorescence imaging such as specimen thickness and topography as well as physiological characteristics of the samples such as tissue autofluorescence and presence of cuticle. The resulting imaging techniques provide interesting qualitative and quantitative information not possible with conventional light or electron 2D imaging. Microsc. Res. Tech., 81:141-152, 2018. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

A revision of the spider genus Raveniola (Araneae, Nemesiidae. I. Species from Western Asia

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Sergei Zonstein

2018-01-01

Full Text Available The genus Raveniola Zonstein, 1987 is found to be represented in Western Asia by 16 species: ♂♀ R. adjarica sp. nov. (Georgia, ♂ R. anadolu sp. nov. (Turkey, ♂ R. arthuri Kunt & Yağmur, 2010 (Turkey, ♂ R. birecikensis sp. nov. (Turkey, ♂♀ R. dunini sp. nov. (Armenia, Azerbaijan, Iran, ♂♀ R. hyrcanica Dunin, 1988 (Azerbaijan, ♂ R. marusiki sp. nov. (Iran, ♂ R. mazandaranica Marusik, Zamani & Mirshamsi, 2014 (Iran, ♂♀ R. micropa (Ausserer, 1871 (Turkey, ♀ R. nana sp. nov. (Turkey, ♂♀ R. niedermeyeri (Brignoli, 1972 (Iran, ♂♀ R. pontica (Spassky, 1937 (Russia, Georgia, ♀ R. sinani sp. nov. (Turkey, ♂♀ R. turcica sp. nov. (Turkey, ♂♀ R. vonwicki Zonstein, 2000 (Iran and ♂♀ R. zaitzevi (Charitonov, 1948 (Azerbaijan, Georgia = ♀ Brachythele recki Mcheidze, 1983, syn. nov. Eight species are newly described; others are redescribed from types and/or conspecific material. Males of R. micropa and R. zaitzevi, hitherto unknown, are described for the first time. Data on the variability, relationships, distribution, and ecology of all considered species are also provided.

Blood-feeding patterns of native mosquitoes and insights into their potential role as pathogen vectors in the Thames estuary region of the United Kingdom.

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Brugman, V A; Hernández-Triana, L M; England, M E; Medlock, J M; Mertens, P P C; Logan, J G; Wilson, A J; Fooks, A R; Johnson, N; Carpenter, S

2017-03-27

The range of vertebrate hosts on which species of mosquito blood-feed is an important parameter for identifying potential vectors and in assessing the risk of incursion and establishment of vector-borne pathogens. In the United Kingdom, studies of mosquito host range have collected relatively few specimens and used techniques that could only broadly identify host species. This study conducted intensive collection and analysis of mosquitoes from a grazing marsh environment in southeast England. This site provides extensive wetland habitat for resident and migratory birds and has abundant human nuisance biting mosquitoes. The aim was to identify the blood-feeding patterns of mosquito species present at the site which could contribute to the transmission of pathogens. Twice-weekly collections of mosquitoes were made from Elmley Nature Reserve, Kent, between June and October 2014. Mosquitoes were collected using resting boxes, by aspiration from man-made structures and using a Mosquito Magnet Pro baited with 1-octen-3-ol. Blood-fed specimens were classified according to the degree of blood meal digestion using the Sella scale and vertebrate origin determined using sequencing of a fragment of the mitochondrial cytochrome C oxidase subunit I gene. Mosquitoes that were morphologically cryptic were identified to species level using multiplex PCR and sequencing methods. A total of 20,666 mosquitoes of 11 species were collected, and 2,159 (10.4%) were blood-fed (Sella scale II-VI); of these 1,341 blood-fed specimens were selected for blood meal analysis. Vertebrate origin was successfully identified in 964 specimens (72%). Collections of blood-fed individuals were dominated by Anopheles maculipennis complex (73.5%), Culiseta annulata (21.2%) and Culex pipiens form pipiens (10.4%). Nineteen vertebrate hosts comprising five mammals and 14 birds were identified as hosts for mosquitoes, including two migratory bird species. Feeding on birds by Culex modestus and Anopheles

Proceedings of the XV symposium neuroradiologicum

International Nuclear Information System (INIS)

Takahashi, Mutsumasa; Korogi, Yukunoru; Moseley, I.

1995-01-01

The 370 proffered papers accepted for presentation included almost 150 oral communications and about 220 posters. On this occasion an emphasis was placed not only on scientific communications, but also on educational programmes. This volume contains the 266 papers accepted for publication from among the proffered papers, plus three special 'New Horizons' lectures. The headings were as follows: New techniques, functional MRI (15 papers), MRA (25 papers), vascular imaging (26 papers), neoplasms (27 papers), degenerative diseases (7 papers), inflammation (10 papers), brain (14 papers), pediatrics (21 papers), spine (23 papers), sella (8 papers), orbit (4 papers), head and neck (16 papers), intervention: aneurysms (10 papers), intervention: angioplasty (17 papers), intervention: fistulae (6 papers), intervention: AVMs (8 papers), spinal fistulae (3 papers), gamma knife (9 papers), contrast media (11 papers), CT (11 papers) as well as nuclear medicine (5 papers). (orig./MG). 589 figs., 154 tabs., 1118 separate illustrations

Three-dimensional analysis of craniofacial bones using three-dimensional computer tomography

Energy Technology Data Exchange (ETDEWEB)

Ono, Ichiro; Ohura, Takehiko; Kimura, Chu (Hokkaido Univ., Sapporo (Japan). School of Medicine) (and others)

1989-08-01

Three-dimensional computer tomography (3DCT) was performed in patients with various diseases to visualize stereoscopically the deformity of the craniofacial bones. The data obtained were analyzed by the 3DCT analyzing system. A new coordinate system was established using the median sagittal plane of the face (a plane passing through sella, nasion and basion) on the three-dimensional image. Three-dimensional profilograms were prepared for detailed analysis of the deformation of craniofacial bones for cleft lip and palate, mandibular prognathia and hemifacial microsomia. For patients, asymmetry in the frontal view and twist-formed complicated deformities were observed, as well as deformity of profiles in the anteroposterior and up-and-down directions. A newly developed technique allows three-dimensional visualization of changes in craniofacial deformity. It would aid in determining surgical strategy, including crani-facial surgery and maxillo-facial surgery, and in evaluating surgical outcome. (N.K.).

Three-dimensional analysis of craniofacial bones using three-dimensional computer tomography

International Nuclear Information System (INIS)

Ono, Ichiro; Ohura, Takehiko; Kimura, Chu

1989-01-01

Three-dimensional computer tomography (3DCT) was performed in patients with various diseases to visualize stereoscopically the deformity of the craniofacial bones. The data obtained were analyzed by the 3DCT analyzing system. A new coordinate system was established using the median sagittal plane of the face (a plane passing through sella, nasion and basion) on the three-dimensional image. Three-dimensional profilograms were prepared for detailed analysis of the deformation of craniofacial bones for cleft lip and palate, mandibular prognathia and hemifacial microsomia. For patients, asymmetry in the frontal view and twist-formed complicated deformities were observed, as well as deformity of profiles in the anteroposterior and up-and-down directions. A newly developed technique allows three-dimensional visualization of changes in craniofacial deformity. It would aid in determining surgical strategy, including crani-facial surgery and maxillo-facial surgery, and in evaluating surgical outcome. (N.K.)

Orthodontic camouflage in the case of a skeletal class III malocclusion.

Science.gov (United States)

Costa Pinho, Teresa M; Ustrell Torrent, Josep M; Correia Pinto, João G R

2004-01-01

To describe the clinical problem of a male patient, 15 years of age, who had a dolichofacial biotype and a Class III skeletal type at the beginning of treatment, manifesting itself at the dental level. To resolve the dental problems, orthodontic camouflage (dentoalveolar compensation) with the extraction of two mandibular premolars was performed. This procedure allowed a more harmonious occlusal relationship at the canine level and provided better occlusal stability of the final result. The procedure choice was based on the fact that some cephalometric values were favorable to attenuation of the skeletal Class III. For example, according to the analyses of Björk and Jarabak, these values are the total sum of 1, 2, 3 (sella angle, articular angle, and gonial angles) and the anterior/posterior facial height (S-Go/Na-Me). However, the same cephalometric data indicate a possible worsening of the existing open bite, which might be corrected with dental extractions and the use of intermaxillary elastics.

Selective preservation of anterior pituitary functions in patients with Sheehan′s syndrome

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Bashir Ahmad Laway

2011-01-01

Full Text Available Background: Sheehan′s syndrome manifests as hypopituitarism following a child birth usually preceded by postpartum hemorrhage. The symptoms range from vague feelings of ill health to symptoms of a full blown panhypopituitarism. A large series of such patients is not described in the literature. Materials and Methods: We present the details of ten women with partial Sheehan′s syndrome. They presented with post-partum hemorrhage and lactation failure. Results: After delivery, seven out of ten patients had regular menstrual cycles indicating preservation of gonadotroph function. Lactotroph, thyrotroph, and somatotroph failure were present in all and corticotrophs preservation was documented in four out of ten patients. The hypophysial magnetic resonance imaging (MRI confirmed empty sella in all. Conclusion: lactotroph, somatotroph and thyrotroph failure are common in patients with Sheehan′s syndrome. In addition to known preservation of gonadotroph axis, corticotroph axis may be preserved in some of these patients arguing against the universal treatment of these patients with glucocorticoids.

Rathke cleft cyst in seven-year-old girl presenting with central diabetes insipidus and review of literature.

Science.gov (United States)

Evliyaoglu, Olcay; Evliyaoglu, Cetin; Ayva, Sebnem

2010-05-01

Rathke cleft cysts (RCC) are benign cysts derived from remnants of Rathke cleft, and are rarely symptomatic in children. Symptoms due to RCC are associated with mass effect and pituitary hormone deficiencies. Slow growth rate of the cyst makes its incidence increase with aging. Here we report on a seven-year-old girl who presented with central diabetes insipidus (CDI). Her sella MRI revealed a lesion in the sellar region which grew rapidly in follow-up. She underwent microneurosurgical operation and the lesion was totally excised. Pathologic examination revealed RCC with degenerative changes. In her follow-up, growth hormone deficiency developed in addition to arginine vasopressin deficiency. Rapid growth of the cyst is not the usual course of RCC's. Mechanisms regarding the cyst growth are unclear as they are in this case. This is the youngest child to date presenting with central diabetes insipidus due to RCC. Rapid growth of RCC can cause CDI in young children.

Quantitative study of the opticocarotid and carotid-oculomotor windows for the interpeduncular fossa, before and after internal carotid artery mobilization and posterior communicating division.

Science.gov (United States)

Kim, Young-Don; Elhadi, Ali M; Mendes, George A C; Maramreddy, Naveen; Agrawal, Abhishek; Kalb, Samuel; Nakaji, Peter; Spetzler, Robert F; Preul, Mark C

2015-03-01

The management of basilar apex (BX) aneurysms remains problematic. We quantified the surgical exposure of the BX through the opticocarotid window (OCW) and the carotid-oculomotor window (COW), before and after mobilization of the internal carotid artery and division of the posterior communicating artery (PCoA). Eleven silicone-injected cadaveric heads were dissected bilaterally. The surgical dissection was divided into 4 major steps: (1) supraorbital modified orbitozygomatic craniotomy, (2) mobilization of the internal carotid artery after drilling out the anterior clinoid process intradurally and cutting the distal dural ring, (3) drilling out the posterior clinoid process and dorsum sellae, and (4) dividing the PCoA from the posterior third portion of the vessel. A frameless navigation system was used to quantify the surgical exposure area of the BX through the OCW and COW. The total surgical area increased significantly from steps 1 to 4 (P PCoA significantly increased the overall surgical area for permanent clip application (P PCoA and height of the BX.

Alteration of maxillary and mandibular growth of adult patients with unoperated isolated cleft palate.

Science.gov (United States)

Yang, Yunqiang; Wu, Yeke; Gu, Yifei; Yang, Qijian; Shi, Bing; Zheng, Qian; Wang, Yan

2013-07-01

The objective of this study was to investigate the effects of cleft palate itself on the growth of maxilla and mandible. Fifty-two adult female patients with unoperated isolated cleft palate and 52 adult female individuals with normal occlusion were included in our study. Computer software was used for lateral cephalometry measurement. Manual measurement was performed for dental cast measurements, and sample t test analysis was applied to analyze the differences between the 2 groups using SPSS 17.0. The sella-nasion-subspinale point angle, subspinale-nasion-supramentale point angle, and maxillary arch length of the cleft group were significantly smaller than those of the control group (P cleft group were significantly larger compared with the control group (P palate height, and palate shelf inclination did not differ between the 2 groups. The measurements did not differ between the submucosal cleft and the overt cleft patients. Cleft palate itself has adverse effects on the maxilla growth with shorter maxillary arch length and wider posterior dental arch width.

MRI of lymphocytic hypophysitis

International Nuclear Information System (INIS)

Feng Feng; Li Mingli; Li Xiaozhen; Meng Chunling; Jin zhengyu

2005-01-01

Objective: To describe the MR findings in patients with lymphocytic hypophysitis (LyH), and to discuss MR diagnostic value and limit in this disease entity and its differentiation with pituitary adenoma. Methods: Five pathologically proven cases of LyH were recruited in this study. The main complaints of the patients were polydipsia, polyuria, and headache. The preoperative MR images and clinical manifestations were analyzed retrospectively. Results: MR findings of the 5 patients with LyH included enlargement of pituitary gland, stalk thickening, disappearance of high signal of neurohypophysis on T 1 WI, and marked Gadolinium enhancement of the lesions. Homogeneous enhancement was found in 2 cases, while heterogeneous enhancement was in 3 cases. Involvement of the cavernous sinus and dura mater on dorsum sella and clivus were found in 2 patients. Conclusion: The diagnosis of LyH should be suggested when the enlarged pituitary gland is associated with central diabetes insipidus, and with/without dysfunction of adenohypophysis. (authors)

Value of computerized tomography in the diagnosis of primary and recurrent pituitary gland tumors

International Nuclear Information System (INIS)

Imhof, H.; Kuester, W.; Eslami-Nejad, S.

1979-01-01

The results of cranial computerized tomography (CCT) of 33 patients with questionable space-occupying lesions in the sella-region are compared with clinical, radiological and surgical reports. Five pituitary gland tumors could be detected for the first time. Four of them are verified by surgery. In eight cases recurrent pituitary glant tumors are suspected. Surprisingly these tumors could be found by surgery only in three cases, while in the remaining five cases only scar-tissue was demonstrable. The high accuracy of CCT in the detection of pituitary gland tumors and the possibility to save the patient expensive and high invasive examinations as well, makes CCT in the presence of corresponding clinical signs to a diagnostic 'must'. It is undecided whether in the cases with possible recurrent tumors, there are real recurrent tumors, which could not be detected by surgery, or only scar tissue. In the latter case scar tissue and recurrent pituitary gland tumors are very similar with CCT. (orig.) 891 MG/orig. 892 CKA [de

Partial hypopituitarism and Langerhans cell histiocytosis

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Balaguruswamy, S; Chattington, P D

2011-01-01

A case of multisystem Langerhans cell histiocytosis with pituitary involvement nearly 20 years after initial presentation. A 48-year-old man had histiocytosis X 22 years ago initially involving the groin; subsequently his external auditory meatus, scalp, gum, mandibular bone, perineum and axilla were involved and treated. The pituitary gland was involved 4 years ago. A thyrotropin-releasing hormone test showed delayed response suggestive of hypothalamic disease. Prolactin levels were normal. A gonadotropin-releasing hormone test showed impaired testosterone and gonadotrophin response in keeping with pituitary disease. A glucagon stimulation test showed an impaired growth hormone response but a normal cortisol increase. MRI pituitary showed an empty sella. There was no evidence of diabetes insipidus. Bone mineral densitometry was normal. He has partial hypopituitarism needing thyroxine and testosterone replacement. He also developed type 2 diabetes mellitus 9 years ago. He is closely monitored for any development of diabetes insipidus and the need for growth hormone supplementation. PMID:22715201

Comparative Genome Structure, Secondary Metabolite, and Effector Coding Capacity across Cochliobolus Pathogens

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Condon, Bradford J.; Leng, Yueqiang; Wu, Dongliang; Bushley, Kathryn E.; Ohm, Robin A.; Otillar, Robert; Martin, Joel; Schackwitz, Wendy; Grimwood, Jane; MohdZainudin, NurAinlzzati; Xue, Chunsheng; Wang, Rui; Manning, Viola A.; Dhillon, Braham; Tu, Zheng Jin; Steffenson, Brian J.; Salamov, Asaf; Sun, Hui; Lowry, Steve; LaButti, Kurt; Han, James; Copeland, Alex; Lindquist, Erika; Barry, Kerrie; Schmutz, Jeremy; Baker, Scott E.; Ciuffetti, Lynda M.; Grigoriev, Igor V.; Zhong, Shaobin; Turgeon, B. Gillian

2013-01-24

The genomes of five Cochliobolus heterostrophus strains, two Cochliobolus sativus strains, three additional Cochliobolus species (Cochliobolus victoriae, Cochliobolus carbonum, Cochliobolus miyabeanus), and closely related Setosphaeria turcica were sequenced at the Joint Genome Institute (JGI). The datasets were used to identify SNPs between strains and species, unique genomic regions, core secondary metabolism genes, and small secreted protein (SSP) candidate effector encoding genes with a view towards pinpointing structural elements and gene content associated with specificity of these closely related fungi to different cereal hosts. Whole-genome alignment shows that three to five of each genome differs between strains of the same species, while a quarter of each genome differs between species. On average, SNP counts among field isolates of the same C. heterostrophus species are more than 25 higher than those between inbred lines and 50 lower than SNPs between Cochliobolus species. The suites of nonribosomal peptide synthetase (NRPS), polyketide synthase (PKS), and SSP encoding genes are astoundingly diverse among species but remarkably conserved among isolates of the same species, whether inbred or field strains, except for defining examples that map to unique genomic regions. Functional analysis of several strain-unique PKSs and NRPSs reveal a strong correlation with a role in virulence.

A Novel and Freely Available Interactive 3d Model of the Internal Carotid Artery.

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Valera-Melé, Marc; Puigdellívol-Sánchez, Anna; Mavar-Haramija, Marija; Juanes-Méndez, Juan A; San-Román, Luis; de Notaris, Matteo; Prats-Galino, Alberto

2018-03-05

We describe a new and freely available 3D interactive model of the intracranial internal carotid artery (ICA) and the skull base that also allows to display and compare its main segment classifications. High-resolution 3D human angiography (isometric voxel's size 0.36 mm) and Computed Tomography angiography images were exported to Virtual Reality Modeling Language (VRML) format for processing in a 3D software platform and embedding in a 3D Portable Document Format (PDF) document that can be freely downloaded at http://diposit.ub.edu/dspace/handle/2445/112442 and runs under Acrobat Reader on Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows for visualisation and interaction through JavaScript-based functions (including zoom, rotation, selective visualization and transparentation of structures or a predefined sequence view of the main segment classifications if desired). The ICA and its main branches and loops, the Gasserian ganglion, the petrolingual ligament and the proximal and distal dural rings within the skull base environment (anterior and posterior clinoid processes, silla turcica, ethmoid and sphenoid bones, orbital fossae) may be visualized from different perspectives. This interactive 3D-PDF provides virtual views of the ICA and becomes an innovative tool to improve the understanding of the neuroanatomy of the ICA and surrounding structures.

Thin-section CT of Cushing's disease

International Nuclear Information System (INIS)

Takahashi, Tatsuo; Kuwayama, Akio; Katoh, Tetsuo; Ichihara, Kaoru; Kageyama, Naoki; Nakamura, Koji.

1983-01-01

Using 1.5 mm contiguous sections with a GE CT/T 8800 scanner, we investigated the sellar regions of 22 cases of Cushing's diseases which had been diagnosed endocrinologically. Each sellar turcica was normal in size, and in only 5 cases were there significant findings on 2 mm-thick sellar-floor polytomography. Nine tumors appeared as regions of a hypodense area, and three tumors were diagnosed by indirect signs, for example, stalk deviation and diaphragmatic plane asymmetry. The other 10 cases, especially those previously operated on or irradiated, were diagnosed as falsely positive or negative. Because it is best of the microadenomas appear hypodense within the strongly contrast-enhanced anterior pituitary glands, it is better for scans to be obtained immediately after rapid intravenous contrast infusion. Hypodense areas of microadenomas are best demonstrated on direct coronal scans or reversed scans of 1.5 mm-thickness thin-slice sections. By these methods, microadenomas, if they are over 5-6 mm in diameter, can appear as hypodense. Sellar floor findings by means of thin-section CT were more sensitive than those of polytomography and had more advantages in local diagnosis. If the tumor were over 4 mm in diameter, local changes in the sellar floor could be demonstrated by thin-section CT, but by polytomography no changes in the sellar floor could be demonstrated until the tumor size reached 6 mm. (author)

Imagining the absent dead: rituals of bereavement and the place of the war dead in German women's art during the First World War.

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Siebrecht, Claudia

2011-01-01

Drawing on women's visual responses to the First World War, this article examines female mourning in wartime Germany. The unprecedented death toll on the battlefronts, military burial practices and the physical distance from the remains of the war dead disrupted traditional rituals of bereavement, hindered closure and compounded women's grief on the home front. In response to these novel circumstances, a number of female artists used their images to reimagine funerary customs, overcome the separation from the fallen and express acute emotional distress. This article analyses three images produced during the conflict by the artists Katharina Heise, Martha Schrag and Sella Hasse, and places their work within the civilian experience of bereavement in war. By depicting the pain of loss, female artists contested the historical tradition of proud female mourning in German society and countered wartime codes of conduct that prohibited the public display of emotional pain in response to soldiers’ deaths. As a largely overlooked body of sources, women's art adds to our understanding of the tensions in wartime cultures of mourning that emerged between 1914 and 1918.

Primary pituitary abscess: case report

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Hanel Ricardo Alexandre

2002-01-01

Full Text Available Pituitary abscesses are potentially life-threatening lesions if not appropriately diagnosed and treated. The authors have operated on more than five hundred cases of pituitary tumors and only one represented a case of pituitary abscess. A 35-year-old woman was investigated for chronic frontal headache. CT scan showed a cystic sellar lesion with ring enhancement after contrast injection leading to an initial diagnosis of pituitary adenoma. She underwent a sublabial transsphenoidal approach to the pituitary gland. After dural opening, purulent material was obtained and no tumor or other associated lesion was detected. There was no evidence of current or previous septicemic illness, meningitis, cavernous sinus thrombosis or sinus infection. Cultures were negative. She was put on antibiotics and discharged after 4 weeks. Nowadays, 10 years after treatment, she is doing well, with no anterior pituitary hormone deficit. MRI shows a partially empty sella without residual lesion and the pituitary stalck is in the midline. The early diagnosis and adequate treatment of this life-threatening lesion may result in excellent prognosis.

CT after transsphenoidal surgery

International Nuclear Information System (INIS)

Tazawa, Satoru

1991-01-01

Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacificaiton, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore, subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration. (author)

CT after transsphenoidal surgery

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Tazawa, Satoru [Tohoku Univ., Sendai (Japan). School of Medicine

1991-03-01

Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacificaiton, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore, subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration. (author).

A case of sibutramine-induced hyperprolactinemia.

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Soares Leaes, Carolina Garcia; Pereira-Lima, Júlia Fernanda Semmelmann; da Costa Oliveira, Miriam

2011-01-01

Several drugs may cause hyperprolactinemia, especially antipsychotic drugs and prokynetic drugs. Serum prolactin concentrations increase within hours after acute administration of these drugs and return to normal within two to four days after cessation of chronic therapy. So far, sibutramine, a sympathomimetic drug used in the management of obesity, was not described to be associated with altered prolactin levels. The purpose of this study is to present a case of sibutramine-induced hiperprolactinemia. A 38-year-old white female patient seeks medical attention complaining of weight gain (Body mass index: 35) associated with anxiety. She started sibutramine treatment and presented with amenogalactorrhea. Hyperprolactinemia was diagnosed (prolactin of 46 and 89.6 ng/mL) with normal thyroid, renal and hepatic function, and a negative pregnancy test. A sella MRI was performed and sibutramine was suspended. Prolactin levels returned to normal within 15 days of sibutramine cessation and remained normal within 90 days of follow-up, with resolution of the amenogalactorrhea syndrome. sibutramine may be considered in differential diagnosis of drug-induced hyperprolactinemia.

A Large PROP1 Gene Deletion in a Turkish Pedigree

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Suheyla Gorar

2018-01-01

Full Text Available Pituitary-specific paired-like homeodomain transcription factor, PROP1, is associated with multiple pituitary hormone deficiency. Alteration of the gene encoding the PROP1 may affect somatotropes, thyrotropes, and lactotropes, as well as gonadotropes and corticotropes. We performed genetic analysis of PROP1 gene in a Turkish pedigree with three siblings who presented with short stature. Parents were first degree cousins. Index case, a boy, had somatotrope, gonadotrope, thyrotrope, and corticotrope deficiency. However, two elder sisters had somatotroph, gonadotroph, and thyrotroph deficiency and no corticotroph deficiency. On pituitary magnetic resonance, partial empty sella was detected with normal bright spot in all siblings. In genetic analysis, we found a gross deletion involving PROP1 coding region. In conclusion, we report three Turkish siblings with a gross deletion in PROP1 gene. Interestingly, although little boy with combined pituitary hormone deficiency has adrenocorticotropic hormone (ACTH deficiency, his elder sisters with the same gross PROP1 deletion have no ACTH deficiency. This finding is in line with the fact that patients with PROP1 mutations may have different phenotype/genotype correlation.

The terrestrial distribution of artificial radioactivity in south-west Scotland

International Nuclear Information System (INIS)

McDonald, Paul; Cook, G.T.; Baxter, M.S.; Thompson, J.C.

1992-01-01

This investigation extends the data base on dispersion of Sella-field-derived radionuclides to the northern Solway coastal zone of south-west Scotland. Results of 10x10 km grid soil survey indicate that the predominant source of 239+240 Pu to the area has been weapons fallout, Chernobyl fallout having greatly modified 134 Cs and 137 Cs inventories. Inland transects reveal little evidence of airborne sea-to-land transfer of Sellafield-derived radionuclides, but riverine systems exhibit regions of significant on-land input from Sellafield via tidal inundation and deposition of particles. Sequential chemical leaching of soil and sediment samples suggests a change in chemical association of plutonium between marine and terrestrial systems. In radiological terms, airborne on-land transfer of Sellafield radionuclides is of negligible significance. Radionuclide inventories in Solway soils are generally well below the limiting values implied by the recommended generalised derived limits (GDL). In some tidally inundated riverbank areas however, 137 Cs, Puα and 241 Am levels occasionally exceed 25% of the appropriate GDL values. (author). 40 refs.; 8 figs.; 7 tabs

A Case of Cushing’s Syndrome due to Ectopic Adrenocorticotropic Hormone Secretion from Esthesioneuroblastoma with Long Term Follow-Up after Resection

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Leslee N. Matheny

2018-01-01

Full Text Available We present a case of a 52-year-old male who developed Cushing’s Syndrome due to ectopic adrenocorticotrophic hormone (ACTH secretion from a large esthesioneuroblastoma (ENB of the nasal sinuses. The patient initially presented with polyuria, polydipsia, weakness, and confusion. Computed tomography scan of the head and magnetic resonance imaging showed a 7 cm skull base mass centered in the right cribriform plate without sella involvement. Work-up revealed ACTH-dependent hypercortisolemia, which did not suppress appropriately after high-dose dexamethasone. Subsequent imaging of the chest, abdomen, and pelvis did not reveal other possible ectopic sources of ACTH secretion besides the ENB. His hospital course was complicated by severe hypokalemia and hyperglycemia before successful surgical resection of the tumor, the biopsy of which showed ENB. Postoperatively, his ACTH level dropped below the limit of detection. In the ensuing 4 months, he underwent adjuvant chemoradiation with carboplatin and docetaxel with good response and resolution of hypokalemia and hyperglycemia, with no sign of recurrence as of 30 months postoperatively. His endogenous cortisol production is rising but has not completely recovered.

Autoimmune hyperthyroidism due to secondary adrenal insufficiency: resolution with glucocorticoids.

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Skamagas, Maria; Geer, Eliza B

2011-01-01

To describe the course of autoimmune hyperthyroid disease in a patient with corticotropin (ACTH) deficiency treated with glucocorticoids. We report the clinical presentation, laboratory data, imaging studies, and management of a patient with weight loss, fatigue, apathy, hallucinations, and arthritis. Autoimmune hyperthyroidism (positive thyroperoxidase and thyroglobulin antibodies and borderline positive thyrotropin receptor antibody) was diagnosed in a 71-year-old woman. New psychotic symptoms prompted brain magnetic resonance imaging, which revealed a partially empty sella. Undetectable morning cortisol, undetectable ACTH, and failure to stimulate cortisol with synthetic ACTH (cosyntropin 250 mcg) secured the diagnosis of long-standing secondary adrenal insufficiency. Hydrocortisone replacement improved the patient's symptoms, resolved the thyroid disease, and decreased thyroid antibody titers. In retrospect, the patient recalled severe postpartum hemorrhage requiring blood transfusion at age 38 years. A Sheehan event probably occurred 33 years before the patient presented with corticotropin deficiency. Hyperthyroidism accelerated cortisol metabolism and provoked symptoms of adrenal insufficiency. The hypocortisolemic state may precipitate hyperimmunity and autoimmune thyroid disease. Rapid resolution of hyperthyroidism and decreased thyroid antibody titers with glucocorticoid treatment support this hypothesis.

MRI Findings of Causalgia of the Lower Extremity Following Transsphenoidal Resection of Pituitary Tumor

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D. Ryan Ormond

2012-01-01

Full Text Available Background. Causalgia is continuing pain, allodynia, or hyperalgesia after nerve injury with edema, changes in skin blood flow, or abnormal sudomotor activity. Here we report a case of lower extremity causalgia following elective transsphenoidal resection of a pituitary tumor in a young man. Clinical Presentation. A 33-year-old man with acromegaly underwent elective sublabial transsphenoidal resection of his pituitary tumor. During the three-hour surgery, the lower limbs were kept in a supine, neutral position with a pillow under the knees. The right thigh was slightly internally rotated with a tape to expose fascia lata, which was harvested to repair the sella. Postoperatively, he developed causalgia in a distal sciatic and common peroneal nerve distribution. Pain was refractory to several interventions. Finally, phenoxybenzamine improved his pain significantly. Conclusions. Malpositioning in the operating room resulted in causalgia in this young man. Phenoxybenzamine improved, and ultimately resolved, his symptoms. Improvement in his pain symptoms correlated with resolution of imaging changes in the distal sciatic and peroneal nerves on the side of injury.

Reliability of a coordinate system based on anatomical landmarks of the maxillofacial skeleton. An evaluation method for three-dimensional images obtained by cone-beam computed tomography

International Nuclear Information System (INIS)

Kimura, Momoko; Nawa, Hiroyuki; Yoshida, Kazuhito; Muramatsu, Atsushi; Fuyamada, Mariko; Goto, Shigemi; Ariji, Eiichiro; Tokumori, Kenji; Katsumata, Akitoshi

2009-01-01

We propose a method for evaluating the reliability of a coordinate system based on maxillofacial skeletal landmarks and use it to assess two coordinate systems. Scatter plots and 95% confidence ellipses of an objective landmark were defined as an index for demonstrating the stability of the coordinate system. A head phantom was positioned horizontally in reference to the Frankfurt horizontal and occlusal planes and subsequently scanned once in each position using cone-beam computed tomography. On the three-dimensional images created with a volume-rendering procedure, six dentists twice set two different coordinate systems: coordinate system 1 was defined by the nasion, sella, and basion, and coordinate system 2 was based on the left orbitale, bilateral porions, and basion. The menton was assigned as an objective landmark. The scatter plot and 95% ellipse of the menton indicated the high-level reliability of coordinate system 2. The patterns with the two coordinate systems were similar between data obtained in different head positions. The method presented here may be effective for evaluating the reliability (reproducibility) of coordinate systems based on skeletal landmarks. (author)

THE RELATIONSHIP BETWEEN TMJ DISORDER AND HEAD AND NECK POSTURE

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Sesi R. Puspita Dewi

2015-06-01

Full Text Available Temporomandibular joint disorders may be caused by variety of factors; one of which is the posture of head and neck. However, this remains controversial and a subject of debate by experts. The objective of this study was to know whether there was a relation between temporomandibular disorders and the head and neck posture seen radiographically. Subjects were 40 dental students from University of Indonesia who met the inclusion criteria, selected through questionnaire, and subjective examination based on Helkimo’s dysfunction index. Then, lateral cephalometric radiographs were done to all subjects. In the radiogram, a horizontal line was made from the nasion point to the sella tursica, and a vertical line was drawn along the prominent bone of C1 – C5. The angle between the two lines was measured, and used to represent the head and neck posture. The design of the study was cross sectional. Based on statistical analysis, there was no significant relationship between the anamnestic dysfunction index as well as the clinical dysfunction index that represented the temporomandibular joint disorders and the posture of the head and neck seen radiographically.

Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism.

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Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon

2016-02-01

Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea.

Intracranial hypertension: A rare presentation of lupus nephritis.

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Yadav, Praveen; Nair, Anishkumar; Cherian, Ajith; Sibi, N S; Kumar, Ashwini

2010-07-01

A 14-year-old male presented with bilateral papilledema, growth retardation and absent secondary sexual characters. He had a past history of fever, headache and fatigue of 6 months duration. The diagnosis of intracranial hypertension (IH) was confirmed by an increased intracranial pressure and normal neuroimaging studies of the brain, except for partial empty sella, prominent perioptic cerebrospinal fluid (CSF) spaces and buckling of optic nerves. Evaluation showed erythrocyte sedimentation rate (ESR) of 150 mm/hr, positive antinuclear antibody (ANA), anti dsDNA and anti ribosomal P protein. Renal biopsy revealed diffuse segmental proliferative lupus nephritis (LN) class IV S (A) confirming the diagnosis of systemic lupus erythematosus (SLE). Treatment of LN with intravenous pulse methyl prednisolone and cyclophosphamide was effective in normalizing the CSF pressure, resulting in express and dramatic resolution of symptomatology. In a case of IH, SLE must be considered. IH, growth retardation and absence of sexual characters may be presenting manifestations of a chronic systemic inflammatory disease like SLE. These manifestations may act as a pointer to associated advanced grades of LN, which can be totally asymptomatic and missed without a renal biopsy.

Endoscopic Endonasal Transsphenoidal Drainage of a Spontaneous Candida glabrata Pituitary Abscess.

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Strickland, Ben A; Pham, Martin; Bakhsheshian, Joshua; Carmichael, John; Weiss, Martin; Zada, Gabriel

2018-01-01

Noniatrogenic pituitary abscess remains a rare clinical entity, and is the indication for surgery in abscess caused by Candida species, and also provide an intraoperative video showing the endoscopic management of this pathology. A 33-year-old woman presented with headache, hypopituitarism, and vision loss in the setting of diabetic ketoacidosis, and was found to have multiple abscesses in the liver, lung, kidney, and uterus. Brain magnetic resonance imaging revealed a 15-mm cystic sellar mass with restricted diffusion. The patient underwent urgent evacuation of the abscess via an endoscopic endonasal transsphenoidal route, with obvious purulent material filling the sella, later identified as Candida glabrata. Antimicrobial therapy was refined appropriately, and she exhibited significant improvement in neurologic function, although endocrinopathy has persisted. With timely management, including a combination of surgical drainage and appropriate antimicrobial therapy, neurologic outcomes are good in most cases of pituitary abscess; however, endocrinopathy often does not improve. Although most reported cases with identified causative organisms speciate bacteria, some cases are of fungal etiology and require different antimicrobial agents. This further underscores the importance of identifying the causative agent. Copyright © 2017 Elsevier Inc. All rights reserved.

Duplication of the pituitary gland associated with multiple blastogenesis defects: Duplication of the pituitary gland (DPG)-plus syndrome. Case report and review of literature.

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Manjila, Sunil; Miller, Erin A; Vadera, Sumeet; Goel, Rishi K; Khan, Fahd R; Crowe, Carol; Geertman, Robert T

2012-01-01

Duplication of the pituitary gland (DPG) is a rare craniofacial developmental anomaly occurring during blastogenesis with postulated etiology such as incomplete twinning, teratogens, median cleft face syndrome or splitting of the notochord. The complex craniocaudal spectrum of blastogenesis defects associated with DPG is examined with an illustrative case. We report for the first time in the medical literature some unique associations with DPG, such as a clival encephalocele, third cerebral peduncle, duplicate odontoid process and a double tongue with independent volitional control. This patient also has the previously reported common associations such as duplicated sella, cleft palate, hypertelorism, callosal agenesis, hypothalamic enlargement, nasopharyngeal teratoma, fenestrated basilar artery and supernumerary teeth. This study also reviews 37 cases of DPG identified through MEDLINE literature search from 1880 to 2011. It provides a detailed analysis of the current case through physical examination and imaging. The authors propose that the developmental deformities associated with duplication of pituitary gland (DPG) occur as part of a developmental continuum, not as chance associations. Considering the fact that DPG is uniquely and certainly present throughout the spectrum of these blastogenesis defects, we suggest the term DPG-plus syndrome.

Quantative flow measurement of the vertebro-basilar circulation for positional vertigo by using 2D phase contrast technique

Energy Technology Data Exchange (ETDEWEB)

Tominaga, Satoru; Seo, Toru; Ishikura, Reiichi; Nakao, Norio [Hyogo Coll. of Medicine, Nishinomiya (Japan); Tabuchi, Yukiko

1996-04-01

Quantative measurements of blood flow in the vertebral and basilar arteries were obtained by the 2D phase contrast (2D PC) technique. In phantom study, flow velocity measured with 2D PC correlated well with actual flow velocity. Sixty-six patients were neurologically normal and 20 had positional vertigo due to vertebrobasilar insufficiency (VBI). Mean velocities (MV) were measured by using a transverse plane in the vertebral arteries at the level of C3 and in the basilar arteries at the level of the sella floor. Volume flow rates (VFR) were calculated as the product of MV and the area of the arteries whose diameters were measured on the basis of pixel counting in the histogram of the signal intensity profile. In the normal group, MV of the left vertebral artery and MV and VFR of the basilar artery showed significant declines as age progressed. In the vertigo group, MV and VFR of the basilar artery were significantly lower than in the normal group. It is concluded that 2D PC technique appears to be fast and easy to handle without cardiac gating to assess blood flow in vessels surrounded by bone tissues. (author).

Quantative flow measurement of the vertebro-basilar circulation for positional vertigo by using 2D phase contrast technique

International Nuclear Information System (INIS)

Tominaga, Satoru; Seo, Toru; Ishikura, Reiichi; Nakao, Norio; Tabuchi, Yukiko.

1996-01-01

Quantative measurements of blood flow in the vertebral and basilar arteries were obtained by the 2D phase contrast (2D PC) technique. In phantom study, flow velocity measured with 2D PC correlated well with actual flow velocity. Sixty-six patients were neurologically normal and 20 had positional vertigo due to vertebrobasilar insufficiency (VBI). Mean velocities (MV) were measured by using a transverse plane in the vertebral arteries at the level of C3 and in the basilar arteries at the level of the sella floor. Volume flow rates (VFR) were calculated as the product of MV and the area of the arteries whose diameters were measured on the basis of pixel counting in the histogram of the signal intensity profile. In the normal group, MV of the left vertebral artery and MV and VFR of the basilar artery showed significant declines as age progressed. In the vertigo group, MV and VFR of the basilar artery were significantly lower than in the normal group. It is concluded that 2D PC technique appears to be fast and easy to handle without cardiac gating to assess blood flow in vessels surrounded by bone tissues. (author)

Las ciudades de la nueva granada: teatro y objeto de los conflictos de la memoria política (1810-1830

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Georges Lomné

1993-01-01

Full Text Available A nuestro parecer, la ciudad colonial fue planeada como si se tratara de un teatro cuya única finalidad hubiera sido la de conmemorar el vasallaje de la Ciudad a los dos poderes de la Conquista. Diminuto resulta, en realidad, el artificio de la metáfora en cuanto la Plaza y sus calles contiguas se asimilan a un auténtico escenario donde se verificaron "ceremonias de la información".' Estas, periódicas u ocasionales, consideran a los vecinos como otros tantos actores y espectadores de una dramaturgia que sella el pacto explícito de su adhesión al estandarte de la Fe y al pendón real. Añadamos que durante el intervalo de tiempo que separa esas manifestaciones rituales, ciertos símbolos arquitectónicos (calvarios, escudos de armas o picotas, colocados en un itinerario determinado de lugares, constituyen, en el sentido del arsmemorativa clásico, unas "imágenes sobresalientes" 2 que refrescan en la mente de quienes las contemplan la memoria de la Pasión de Cristo, la de la Gloria del Príncipe o de su justicia ejemplar...

Suppression of Tinnitus in a Patient with Unilateral Sudden Hearing Loss: A Case Report

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Alessandra Fioretti

2012-01-01

Full Text Available We describe a case of a 67-year-old woman with severe disabling right-sided tinnitus, mild hyperacusis, and headache. The tinnitus was associated with sudden right hearing loss and vertigo, which occurred about 18 months before. Magnetic resonance imaging (MRI resulted in normal anatomical structures of the cochlea and of the cranial nerves showing a partial empty sella syndrome with suprasellar cistern hernia. Angio-MR revealed a bilateral contact between the anterior-inferior cerebellar artery (AICA and the acoustic-facial nerve with a potential neurovascular conflict. Surgery was considered unnecessary after further evaluations. The right ear was successfully treated with a combination device (hearing aid plus sound generator. Shortly after a standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and headache which completely disappeared at the follow-up evaluation after 3, 6, and 12 months. This paper demonstrates that the combination device resulted in a complete tinnitus and hyperacusis suppression in a patient with unilateral sensorineural sudden hearing loss. Our paper further supports the restoration of peripheral sensory input for the treatment of tinnitus associated with hearing loss in selected patients.

Skeletal manifestations of juvenile hypothyroidism and the impact of treatment on skeletal system.

Science.gov (United States)

Gutch, Manish; Philip, Rajeev; Philip, Renjit; Toms, Ajit; Saran, Sanjay; Gupta, K K

2013-10-01

Thyroid hormone mediates growth and development of the skeleton through its direct effects and through its permissive effects on growth hormone. The effect of hypothyroidism on bone is well described in congenital hypothyroidism, but the impact of thyroid hormone deficiency on a growing skeleton, as it happens with juvenile hypothyroidism, is less defined. In addition, the extent to which the skeletal defects of juvenile hypothyroidism revert on the replacement of thyroid hormone is not known. A study was undertaken in 29 juvenile autoimmune hypothyroid patients to study the skeletal manifestations of juvenile hypothyroidism and the impact of treatment of hypothyroidism on the skeletal system of juvenile patients. Hypothyroidism has a profound impact on the skeletal system and delayed bone age, dwarfism, and thickened bands at the metaphyseal ends being the most common findings. Post treatment, skeletal findings like delayed bone age and dwarfism improved significantly, but there were no significant changes in enlargement of sella, presence of wormian bones, epihyseal dysgenesis, vertebral changes and thickened band at the metaphyseal ends. With the treatment of hypothyroidism, there is an exuberant advancement of bone age, the catch up of bone age being approximately double of the chronological age advancement.

Linear versus circular polarization of head coils - comparison on phantom and in the clinic

International Nuclear Information System (INIS)

Schratter, M.; Kramer, J.; Prayer, L.; Wimberger, D.; Imhof, H.; Schmid, W.

1990-01-01

Two different head coils - one with linear polarization and the other with circular polarization - were compared under the same measurement conditions. Comparison was done on a phantom with waterfilled and gadolinium-filled pin-holes, as well as on anatomical MR images of 23 volunteers. In three volunteers the whole brain was examined while, in the remaining 20 volunteers the sella region or cerebellopontine angleregion was examined. Criteria for comparison were signal-to-noise ratio, background noise, and detail resolution (phantom), as well as subjective criteria - image sharpness, anatomical, contrast, and recognition of anatomical details -, evaluated on anatomical MR images by four radiologists independently of each other. The results show a significant improvement of signal-to-noise ratio, lower background noise and therefore marked improvement of images harpness, and moderate improvement in the recognition of anatomical details using the circular polarized head coil; as for as detail resolution and anatomical contrast were concerned, however, no significant difference was seen between the two coils. Major advantages of the circular, polarized head coil in clinical application are shorter measurement times (reduced number of acquisitions), as well as thinner slices without loss of signal-to-noise ratio. (orig.) [de

Pituitary magnetic resonance imaging experience in Jordan

International Nuclear Information System (INIS)

Hadidy, Azmy M.; Jallad, Dana G.; Haroun, Azmi A.; Mahafza, Waleed S.; Ajlouni, Kamel M.

2009-01-01

To assess the pituitary findings as demonstrated on MRI and to compare the results with the data published in the literature. One thousand, one hundred and thirty-eight pituitary MRIs with and without intravenous contrast media (gadolinium) were performed over 6 years from 2001 to 2007 in the Department of Diagnostic Radiology, Jordan University Hospital, Amman, Jordan. The patients were referred from various departments and were evaluated for pituitary, other sellar, and juxtasellar abnormalities. The results were compared with those in the published literature. Four hundred and eight-three normal scans were excluded from the study. The remaining 655 were abnormal, pituitary adenoma was detected in 327 (49.9%), microadenoma was present in 213 (32.5%), and macroadenoma in 114 (17.4%). Partial empty sella was seen in 157 (24%), diffuse pituitary gland enlargement in 98 (14.9%), ectopic pituitary posterior lobe in 13 (2%), and other findings in 31 (4.7%). The incidence of pituitary adenoma was equal in both genders; however, microadenoma was more common, affected a younger age group, and was predominately seen in females. The other parameters showed agreement with the published literature. (author)

Robotic Anterior and Midline Skull Base Surgery: Preclinical Investigations

International Nuclear Information System (INIS)

O'Malley, Bert W.; Weinstein, Gregory S.

2007-01-01

Purpose: To develop a minimally invasive surgical technique to access the midline and anterior skull base using the optical and technical advantages of robotic surgical instrumentation. Methods and Materials: Ten experimental procedures focusing on approaches to the nasopharynx, clivus, sphenoid, pituitary sella, and suprasellar regions were performed on one cadaver and one live mongrel dog. Both the cadaver and canine procedures were performed in an approved training facility using the da Vinci Surgical Robot. For the canine experiments, a transoral robotic surgery (TORS) approach was used, and for the cadaver a newly developed combined cervical-transoral robotic surgery (C-TORS) approach was investigated and compared with standard TORS. The ability to access and dissect tissues within the various areas of the midline and anterior skull base were evaluated, and techniques to enhance visualization and instrumentation were developed. Results: Standard TORS approaches did not provide adequate access to the midline and anterior skull base; however, the newly developed C-TORS approach was successful in providing the surgical access to these regions of the skull base. Conclusion: Robotic surgery is an exciting minimally invasive approach to the skull base that warrants continued preclinical investigation and development

Detection of transgenerational barium dual-isotope marks in salmon otoliths by means of LA-ICP-MS.

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Huelga-Suarez, Gonzalo; Fernández, Beatriz; Moldovan, Mariella; García Alonso, J Ignacio

2013-03-01

The present study evaluates the use of an individual-specific transgenerational barium dual-isotope procedure and its application to salmon specimens from the Sella River (Asturias, Spain). For such a purpose, the use of laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) in combination with multiple linear regression for the determination of the isotopic mark in the otoliths of the specimens is presented. In this sense, a solution in which two barium-enriched isotopes ((137)Ba and (135)Ba) were mixed at a molar ratio of ca. 1:3 (N Ba137/N Ba135) was administered to eight returning females caught during the spawning period. After injection, these females, as well as their offspring, were reared in a governmental hatchery located in the council of Cangas de Onís (Asturias, Spain). For comparison purposes, as well as for a time-monitoring control, egg and larva data obtained by solution analysis ICP-MS are also given. Otoliths (9-month-old juveniles) of marked offspring were analysed by LA-ICP-MS demonstrating a 100 % marking efficacy of this methodology. The capabilities of the molar fraction approach for 2D imaging of fish otoliths are also addressed.

Diagnostic value of the digital subtraction angiography of brain tumors. With special reference to the significance of tumor stains

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Hirata, Yoshifumi; Matsukado, Yasuhiko; Takahashi, Mutsumasa

1986-10-01

Digital subtraction angiography (DSA) in 110 cases of brain tumors were studied in comparison with conventional angiography (CA). The dural sinuses and tumor stains of meningiomas, particularly tuberculum sellae meningioma, were better shown by intravenous DSA (IV-DSA) than by CA. IV-DSA clearly demonstrated bilateral carotid arteries and was able to rule out the coexistence of the intracranial aneurysm in 88 % of 32 cases with pituitary adenomas. Combination of IV-DSA and high resolution computed tomography has replaced CA to determine surgical indication of patients with pituitary adenomas. Intra-arterial DSA (IA-DSA) was diagnostic and well comparable to CA in identifying main cerebral vasculature over 1 mm in diameter. As to the small arteries under 1 mm and fine tumor vessels, IA-DSA provided less information or none at all. However, IA-DSA was superior to CA for visualization of tumor stains. Not only in most of meningiomas and hemangioblastomas, but in some astrocytomas and oligodendrogliomas, marked tumor stains were well demonstrated on DSA, and DSA provided surgical anatomy for neurosurgeons because of high contrast resolutions. Careful attention should be paid because tumor stains may overestimate tumor vascularity.

Efeito da expansão palatina sobre o processo pterigoide, sincondrose esfeno-occipital e sela turca em crânios com relação esquelética classe II e classe III pela análise de elementos finitos (AEF) = Effect of the palatal expansion on the pterygoid process, spheno-occipital synchondrosis and sella turcica in skulls with class II and class III skeletal relationship by finite element analysis (FEA)

OpenAIRE

Manuel Gustavo Chávez Sevillano

2015-01-01

Resumo: A Técnica de Expansão Palatina é usada frequentemente para corrigir a mordida cruzada posterior, atresia transversal maxilar e aumentar o perímetro da arcada dentária. O objetivo deste estudo foi avaliar pela análise de elementos finitos o efeito simulado da expansão palatina sobre o processo pterigoide, sincondrose esfeno-occipital e sela turca em dois crânios com relação esquelética tipo Classe II e Classe III, identificando a distribuição das tensões mecânicas nessas estruturas ana...

Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature

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Constantine L. Karras

2016-01-01

Full Text Available Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20. Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment.

Development of the orbital region in the chondrocranium of Caretta caretta. Reconsideration of the vertebrate neurocranium configuration.

Science.gov (United States)

Kuratani, S

1989-01-01

By studying the development of the orbital region in the Loggarhead turtle (Caretta caretta) and some placental mammals, it has become clear that the orbital region of the neurocranium should not be regarded as merely a "bowl" to contain the brain, but rather that its ventral part is originally flexured along with the cephalic flexure of the neural tube. At this flexure, the neurocranium is to be divided into 2 parts, the anterior and posterior. The anterior part of the neurocranial sheet is medially perforated by the infundibulum and gives rise to pila metoptica laterally. The post orbital cartilage represents the posterior part. From the above "Bauplan" of the neurocranium, the following conclusions can be drawn: (1) the simple homology of the reptilian and placental mammalian pila metoptica is questionable; (2) the pila antotica is produced by the absorption of the mid-dorsal part of the postorbital cartilage, while the dorsum sellae in mammals is produce by the chondrification of the middle part of the same anlage; (3) homology of the ala hypochiasmatica in mammals with the supratrabecular cartilage in reptiles is more feasible than with the cartilago hypochiasmatica; and (4) the crista sellaris in reptiles is not a part of the primary cranial wall but probably of secondary production.

Reformatted CT diagnosis of pituitary microadenomas in hyperprolactinemic women

International Nuclear Information System (INIS)

Sakamoto, Tetsuya; Kikuchi, Kenji; Kowada, Masayoshi; Hariu, Mineko; Miyauchi, Koji

1983-01-01

The CT diagnosis of pituitary microadenomas was made in 13 among 20 female sterile patients with hyperprolactinemia, utilizing sagittal- and coronal-sectioned reformation on the basis of 1.5 mm-sliced high-resolution axial CT scanning. The pituitary stalk was found to have been shifted in 10 patients, and in all of them adenomas were verified. This was in contrast to the findings that, among another 10 patients with no definite evidence of the stalk shifting, only 3 patients had adenomas. Pituitary adenomas were present in 11 of the 12 patients demonstrating the pituitary suface in a ''convex'' fashion. In contrast, 2 among 6 patients with a ''flat'' surface demonstrated the presence of pituitary adenomas. Enhancement patterns in the sella could be classified as of four types: homogeneous, diffuse-low, punched-out, and nodular types. The adenomas tended to occur in either the nodular or diffuse-low type; they were less frequently seen in the punched-out or homogeneous type. With regard to the correlation between the patterns of contrast enhancement and the serum concentrations of prolactin, it may be of note that the nodular type corresponded well to the higher prolactin serum level, and the homogeneous type to the lower level. (author)

Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report.

Science.gov (United States)

Wang, X-X; Wang, X; Li, Z-L; Yi, B; Liang, C; Jia, Y-L; Zou, B-S

2009-12-01

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

Skeletal manifestations of juvenile hypothyroidism and the impact of treatment on skeletal system

Directory of Open Access Journals (Sweden)

Manish Gutch

2013-01-01

Full Text Available Thyroid hormone mediates growth and development of the skeleton through its direct effects and through its permissive effects on growth hormone. The effect of hypothyroidism on bone is well described in congenital hypothyroidism, but the impact of thyroid hormone deficiency on a growing skeleton, as it happens with juvenile hypothyroidism, is less defined. In addition, the extent to which the skeletal defects of juvenile hypothyroidism revert on the replacement of thyroid hormone is not known. A study was undertaken in 29 juvenile autoimmune hypothyroid patients to study the skeletal manifestations of juvenile hypothyroidism and the impact of treatment of hypothyroidism on the skeletal system of juvenile patients. Hypothyroidism has a profound impact on the skeletal system and delayed bone age, dwarfism, and thickened bands at the metaphyseal ends being the most common findings. Post treatment, skeletal findings like delayed bone age and dwarfism improved significantly, but there were no significant changes in enlargement of sella, presence of wormian bones, epihyseal dysgenesis, vertebral changes and thickened band at the metaphyseal ends. With the treatment of hypothyroidism, there is an exuberant advancement of bone age, the catch up of bone age being approximately double of the chronological age advancement.

Diabetes insipidus--diagnosis and management.

Science.gov (United States)

Di Iorgi, Natascia; Napoli, Flavia; Allegri, Anna Elsa Maria; Olivieri, Irene; Bertelli, Enrica; Gallizia, Annalisa; Rossi, Andrea; Maghnie, Mohamad

2012-01-01

Central diabetes insipidus (CDI) is the end result of a number of conditions that affect the hypothalamic-neurohypophyseal system. The known causes include germinoma/craniopharyngioma, Langerhans cell histiocytosis (LCH), local inflammatory, autoimmune or vascular diseases, trauma resulting from surgery or an accident, sarcoidosis, metastases and midline cerebral and cranial malformations. In rare cases, the underlying cause can be genetic defects in vasopressin synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits. The diagnosis of the underlying condition is challenging and raises several concerns for patients and parents as it requires long-term follow-up. Proper etiological diagnosis can be achieved via a series of steps that start with clinical observations and then progress to more sophisticated tools. Specifically, MRI identification of pituitary hyperintensity in the posterior part of the sella, now considered a clear marker of neurohypophyseal functional integrity, together with the careful analysis of pituitary stalk shape and size, have provided the most striking findings contributing to the diagnosis and understanding of some forms of 'idiopathic' CDI. MRI STIR (short-inversion-time inversion recovery sequencing) is a promising technology for the early identification of LCH-dependent CDI. Copyright © 2012 S. Karger AG, Basel.

Long-Term Stability of Pre-Orthodontic Orthognathic Bimaxillary Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Surgery.

Science.gov (United States)

Jeong, Jeong-Hwa; Choi, Sung-Hwan; Kim, Kee-Deog; Hwang, Chung-Ju; Lee, Sang-Hwy; Yu, Hyung-Seog

2018-02-20

The aim of the present study was to compare the long-term stability of bimaxillary surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment. The present retrospective study included 31 consecutive patients with skeletal Class III malocclusions who had undergone bimaxillary surgery (Le Fort I osteotomy and bilateral IVRO). Patients were divided into 2 groups based on treatment type: pre-orthodontic orthognathic surgery (POGS; n = 17) and conventional surgery with presurgical orthodontic treatment (CS; n = 14). Lateral cephalograms were obtained before surgery, 1 day after surgery, 1 month after surgery, 1 year after surgery, and 2 years after surgery to evaluate skeletal and soft tissue changes between the 2 groups. Data were analyzed using χ 2 tests, Mann-Whitney U tests, repeated-measures analyses of variance, and independent t tests. There was no significant difference in skeletal or soft tissue measurements-with the exception of the angle between the sella-and-nasion plane and the occlusal plane (SN-OP; P surgery. These findings suggest that POGS and CS have similar long-term stability in patients with skeletal Class III malocclusion. Copyright © 2018. Published by Elsevier Inc.

Endoscopic endonasal skull base surgery: advantages, limitations, and our techniques to overcome cerebrospinal fluid leakage: technical note.

Science.gov (United States)

Ishii, Yudo; Tahara, Shigeyuki; Teramoto, Akira; Morita, Akio

2014-01-01

In recent years, resections of midline skull base tumors have been conducted using endoscopic endonasal skull base (EESB) approaches. Nevertheless, many surgeons reported that cerebrospinal fluid (CSF) leakage is still a major complication of these approaches. Here, we report the results of our 42 EESB surgeries and discuss the advantages and limits of this approach for resecting various types of tumors, and also report our technique to overcome CSF leakage. All 42 cases involved midline skull base tumors resected using the EESB technique. Dural incisions were closed using nasoseptal flaps and fascia patch inlay sutures. Total removal of the tumor was accomplished in seven pituitary adenomas (33.3%), five craniopharyngiomas (62.5%), five tuberculum sellae meningiomas (83.3%), three clival chordomas (100%), and one suprasellar ependymoma. Residual regions included the cavernous sinus, the outside of the intracranial part of the internal carotid artery, the lower lateral part of the posterior clivus, and the posterior pituitary stalk. Overall incidence of CSF leakage was 7.1%. Even though the versatility of the approach is limited, EESB surgery has many advantages compared to the transcranial approach for managing mid-line skull base lesions. To avoid CSF leakage, surgeons should have skills and techniques for complete closure, including use of the nasoseptal flap and fascia patch inlay techniques.

Morphological changes of the facial skeleton in Class II/1 patients treated with orthodontic functional appliances

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Dana Festila

2014-01-01

Full Text Available Aim: The aim of this study was to investigate, using lateral cephalometry, the skeletal changes in maxillary bones induced through functional jaw orthopedic therapy. 30 patients with class II division 1 malocclusion and average age of 10.4 years were included in the study. Material and Methods: Cephalometric data were analyzed with the following methods: Burstone, McNamara, Rickets, Tweed and Wits and treatment changes were evaluated overlapping the lateral cephalograms on cranial base with sella registered. Results: The results showed reduced over-jet in average with 2.46 mm, mandibular advancement with a mean value of 2.72 mm and increasing of the total mandibular length with a mean value of 4.17 mm. Although we found an inhibiting in the anterior development of the maxilla with an average of 1.57 degree, the decrease of the anterior-posterior discrepancy was due especially to the mandible. Conclusions: It can be concluded that functional appliances were effective in correcting class II malocclusion. Changes of the position and mandible′s length determined improved facial profile but did not correct it completely because of the chin that moved not only anterior but also downward, as a result of vertical ramus growth.

Variations and Anomalies of the circle of Willis in Korean: Cerebral digital subtraction angiogram studies in 200 case

International Nuclear Information System (INIS)

Lee, Ouk; Chung, Gyoo Sik; Kim, So Sun; Huh, Jin Do; Kim, Ho Joon; Joh, Young Duk

1989-01-01

In order to evaluate the variations of the circle of Willis in Korean population, digital subtraction angiograms in 200 cases were retrospectively analyzed. There was non-visualization of the anterior communicating artery and the posterior communicating artery in 41 cases and this was the most common type 4 vessel cerebral angiogram (20.5%). Unilateral or bilateral non-visualization of the posterior communicating artery was noted in 40 case (20%). The fetal origin of the posterior cerebral artery from the internal carotid artery was seen in 22 cases (11%). In 20 out of 22 cases, there were non-visualization of either the anterior communicating or posterior communicating artery. Visualization of the anterior communicating artery was noted in 102 cases (51%) and of the posterior communicating artery in 87 cases (43.5%). Hypoplasia of the anterior cerebral artery was noted in 24 cases (12%). Non- visualization of the anterior communicating artery or unilateral posterior communicating artery is noted in 16 cases (8%). Non- visualization of the anterior communicating artery was seen in 14 cases (7%). The most common type in appearance of the basilar artery variation was straight type (Type 1: 51%) and the bifurcation of the basilar artery was most commonly located above the posterior clinoid process of the dorsum sellae (58%) on vertebral angiogram

Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma.

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Fuminari, Komatsu; Hideki, Atsumi; Manabu, Osakabe; Mitsunori, Matsumae

2015-01-01

We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure. A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.

A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis

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Nestoras Mathioudakis

2012-01-01

Full Text Available Pituitary adenomas are the most common cause of a sellar mass. Metastases to the pituitary gland, a rare occurrence, may mimic benign pituitary adenomas. We report here a case of a 61-year-old woman with an 80-pack-year smoking history who presented with headache and diplopia. Visual field testing demonstrated bitemporal hemianopsia. Pituitary MRI revealed a 2.0 cm sellar mass impinging upon the optic chiasm. Hypopituitarism was present, with no evidence of diabetes insipidus. The patient was referred to our service for transsphenoidal resection of a presumed pituitary macroadenoma. As part of her preoperative evaluation, a chest radiograph was obtained, which showed a large hilar mass. In light of the patient’s extensive smoking history, the differential diagnosis was expanded to include metastatic lesion to the sella. Transsphenoidal resection of the tumor was performed and histopathology revealed small cell carcinoma. The patient received chemotherapy, but died 18 months later due to widespread brain metastases. Although the presence of diabetes insipidus may help to discriminate between pituitary adenomas and metastatic lesions, this is not a sensitive finding. This case illustrates the need for maintaining a high index of suspicion for pituitary metastasis in patients with known risk factors for malignancy.

Skull Base Meningiomas and Cranial Nerves Contrast Using Sodium Fluorescein: A New Application of an Old Tool.

Science.gov (United States)

da Silva, Carlos Eduardo; da Silva, Vinicius Duval; da Silva, Jefferson Luis Braga

2014-08-01

Objective The identification of cranial nerves is one of the most challenging goals in the dissection of skull base meningiomas. The authors present an application of sodium fluorescein (SF) in skull base meningiomas with the purpose of improving the identification of cranial nerves. Design A prospective study within-subjects design. Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil. Participants Patients with skull base meningiomas. Main Outcomes Measures Cranial nerve identification. Results The group of nine meningiomas was composed of one cavernous sinus, three petroclival, one tuberculum sellae, two sphenoid wing, one olfactory groove, and one temporal floor meningioma. The SF enhancement in all tumors was strong, and the contrast with cranial nerves clearly evident. There were one definite olfactory nerve deficit, one transient abducens deficit, and one definite hemiparesis. All lesions were resected (Simpson grades 1 and 2). The analysis of the difference of the delta SF wavelength between the meningiomas and cranial nerve contrast was performed by the Wilcoxon signed rank test and showed p = 0.011. Conclusions The contrast between the enhanced meningiomas and cranial nerves was evident and assisted in the visualization and microsurgical dissection of these structures. The anatomical preservation of these structures was improved using the contrast.

Quantification and detoxification of aflatoxin in food items

Energy Technology Data Exchange (ETDEWEB)

Nisa, A. U.; Hina, S.; Ejaz, N. [Pakistan Council of Scientific and Industrial Research Laboratories, Lahore (Pakistan). Dept. of Food and Biotechnology

2013-07-15

The present study was conducted to quantify and detoxify the antitoxins in food items. For this purpose, total 30 samples of food were collected. The samples were quantified using thin layer chromatography (TLC) for the presence of aflatoxin level in food items. Out of them aflatoxins were not found in 10 samples. Remaining 20 aflatoxins +ve samples were treated with various chemical solutions i.e. 0.1% HCl, 0.3%HCl, 0.5% HCI, 10% citric acid, 30% citric acid, 50% calcium hydroxide, 0.2 and 0.3% NaOCl, 96% ethanol and 99% acetone for detoxification. The aflatoxins were reduced to 55.1%, 90.9%, 28.08% and 80.0% in Super Sella rice, Super Basmati rice, Brown rice and White rice, respectively. The aflatoxin level was reduced in maize grain, damaged wheat, peanut, figs and dates upto 31.3 %, 64.3 %, 63.6%, 42.7% and 19.8%, respectively. Aflatoxins were detoxified in cereals Dal Chana, Dal Mash, Dal Masoor, turmeric (Haldi) and Nigela seeds (Kalwangi) upto 70.5%, 83.0%, 46.2%, 82.09% and 36.9%, respectively. Reduction of aflatoxins was carried out 39.7 %,7.l % 39.5% 82.0% and 62.0% in red chilli, makhana, corn flakes, desert (Kheer Mix) and pistachio. The significant results (p = 0.042) of detoxification of aflatoxins in food items were obtained from present study. (author)

Optimized diagnostic performance of brain magnetic resonance imaging in children with idiopathic growth hormone deficiency

International Nuclear Information System (INIS)

Rac, M.

2006-01-01

Purpose: The aim of this study was to search for correlations between anatomic changes in the pituitary gland and hormonal disturbances in children with short stature. Material and methods: Children with short stature were enrolled when criteria of pituitary growth hormone deficiency were partly or completely met. Magnetic resonance imaging was performed in 87 children and particular attention was given to the pituitary gland. Measurements were compared with pituitary dimensions accepted as normal in the literature. Contrast with GdDTPA was used to visualize the pituitary gland and associated structures (stalk, infundibulum). T1-weighted images in the sagittal and coronal planes were obtained. The results were statistically analyzed with non-parametric tests. Conclusions: 1. Magnetic resonance imaging is a very sensitive method for detecting changes in the pituitary gland and may well be recommended as a method of choice even though the percentage of changes detected with it is rather small. 2. The use of contrast agent may be abandoned to limit costs when searching for cause of growth deficit in children with idiopathic growth hormone deficiency, save for the following cases: hypoplasia or aplasia of the pituitary gland, transection of the stalk, empty sella syndrome or tumor in the central nervous system. 3. Pituitary volume and height appear to be of greatest diagnostic significance, while width (which varies little) can serve as an auxiliary parameter. (author)

Olfactory groove meningiomas.

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Hentschel, Stephen J; DeMonte, Franco

2003-06-15

Olfactory groove meningiomas (OGMs) arise over the cribriform plate and may reach very large sizes prior to presentation. They can be differentiated from tuberculum sellae meningiomas because OGMs arise more anterior in the skull base and displace the optic nerve and chiasm inferiorly rather than superiorly. The authors searched the neurosurgery database at the M. D. Anderson Cancer Center for cases of OGM treated between 1993 and 2003. The records of these patients were then reviewed retrospectively for details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status. Thirteen patients, (12 women and one man, mean age 56 years) harbored OGMs (mean size 5.7 cm). All patients underwent bifrontal craniotomies and biorbital osteotomies. There were 11 complete resections (including the hyperostotic bone and dura of the cribriform plate and any extension into the ethmoid sinuses) and two subtotal resections with minimal residual tumor left in patients with recurrent lesions. No complication directly due to the surgery occurred in any patient. There were no recurrences in a mean follow-up period of 2 years (range 0-5 years). With current microsurgical techniques, the results of OGM resection are excellent, with a high rate of total resection and a low incidence of complications. All hyperostotic bone should be removed with the dura of the anterior skull base to minimize the risk of recurrence.

One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: Craniofacial outcomes.

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Fudalej, Piotr Stanislaw; Wegrodzka, Ewa; Semb, Gunvor; Hortis-Dzierzbicka, Maria

2015-09-01

The aim of this study was to compare facial development in subjects with complete unilateral cleft lip and palate (CUCLP) treated with two different surgical protocols. Lateral cephalometric radiographs of 61 patients (42 boys, 19 girls; mean age, 10.9 years; SD, 1) treated consecutively in Warsaw with one-stage repair and 61 age-matched and sex-matched patients treated in Oslo with two-stage surgery were selected to evaluate craniofacial morphology. On each radiograph 13 angular and two ratio variables were measured in order to describe hard and soft tissues of the facial region. The analysis showed that differences between the groups were limited to hard tissues – the maxillary prominence in subjects from the Warsaw group was decreased by almost 4° in comparison with the Oslo group (sella-nasion-A-point (SNA) = 75.3° and 79.1°, respectively) and maxillo-mandibular morphology was less favorable in the Warsaw group than the Oslo group (ANB angle = 0.8° and 2.8°, respectively). The soft tissue contour was comparable in both groups. In conclusion, inter-group differences suggest a more favorable outcome in the Oslo group. However, the distinctiveness of facial morphology in background populations (ie, in Poles and Norwegians) could have contributed to the observed results. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Automated Extraction of Cranial Landmarks from Computed Tomography Data using a Combined Method of Knowledge and Pattern Based Approaches

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Roshan N. RAJAPAKSE

2016-03-01

Full Text Available Accurate identification of anatomical structures from medical imaging data is a significant and critical function in the medical domain. Past studies in this context have mainly utilized two main approaches, the knowledge and learning methodologies based methods. Further, most of previous reported studies have focused on identification of landmarks from lateral X-ray Computed Tomography (CT data, particularly in the field of orthodontics. However, this study focused on extracting cranial landmarks from large sets of cross sectional CT slices using a combined method of the two aforementioned approaches. The proposed method of this study is centered mainly on template data sets, which were created using the actual contour patterns extracted from CT cases for each of the landmarks in consideration. Firstly, these templates were used to devise rules which are a characteristic of the knowledge based method. Secondly, the same template sets were employed to perform template matching related to the learning methodologies approach. The proposed method was tested on two landmarks, the Dorsum sellae and the Pterygoid plate, using CT cases of 5 subjects. The results indicate that, out of the 10 tests, the output images were within the expected range (desired accuracy in 7 instances and acceptable range (near accuracy for 2 instances, thus verifying the effectiveness of the combined template sets centric approach proposed in this study.

Sheehan's Syndrome Presenting with Early Postpartum Congestive Heart Failure

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Shu-Yi Wang

2005-08-01

Full Text Available We report the case of a young woman with Sheehan's syndrome who presented with ventricular arrhythmia and congestive heart failure. The patient was admitted because of postpartum hemorrhage and hypovolemic shock; a massive blood transfusion was required to restore blood volume. After initial stabilization, the patient developed acute respiratory distress and congestive heart failure accompanied by hemodynamic instability 2 weeks after delivery. Episodes of ventricular tachycardia of the torsade de pointes type and a prolonged QT interval were noted on baseline electrocardiogram. A low cortisol level was found incidentally, which led to the suspicion of hypopituitarism. The diagnosis was later supported by laboratory findings of multiple pituitary hormone deficiencies. After administration of corticosteroids and thyroxine, the patient's clinical condition improved dramatically. A pituitary magnetic resonance imaging scan 32 days after delivery revealed a diminished and flattened pituitary gland with prominent intrasellar cerebrospinal fluid loculation, which was compatible with the clinical diagnosis of empty sella with panhypopituitarism. The syndrome of acute anterior pituitary necrosis secondary to postpartum hemorrhage and shock was first described by Sheehan in 1939. Although the occurrence of Sheehan's syndrome is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency. Appropriate hormone replacement therapy is essential and always results in dramatic clinical improvement.

Craniofacial and brain abnormalities in Laron syndrome (primary growth hormone insensitivity).

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Kornreich, L; Horev, G; Schwarz, M; Karmazyn, B; Laron, Z

2002-04-01

To investigate abnormalities in the craniofacial structures and in the brain in patients with Laron syndrome. Eleven patients with classical Laron syndrome, nine untreated adults aged 36-68 years and two children aged 4 and 9 years (the latter treated by IGF-I), were studied. Magnetic resonance images of the brain were obtained in all the patients. One patient also underwent computed tomography. The maximal diameter of the maxillary and frontal sinuses was measured and compared with reference values, the size of the sphenoid sinus was evaluated in relation to the sella, and the mastoids were evaluated qualitatively (small or normal). The brain was evaluated for congenital anomalies and parenchymal lesions. In the adult untreated patients, the paranasal sinuses and mastoids were small; in six patients, the bone marrow in the base of the skull was not mature. The diploe of the calvaria was thin. On computed tomography in one adult patient, the sutures were still open. A minimal or mild degree of diffuse brain parenchymal loss was seen in ten patients. One patient demonstrated a lacunar infarct and another periventricular high signals on T2-weighted images. Two patients had cerebellar atrophy. The present study has demonstrated the important role IGF-I plays in the development of the brain and bony structures of the cranium.

Intracranial intrasellar kissing carotid arteries: case report Artérias carótidas intracranianas intra-selares "que se beijam": relato de caso

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Arthur de Azambuja Pereira Filho

2007-06-01

Full Text Available Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.Artérias carótidas intracranianas "que se beijam" representam rara variação da anatomia arterial, onde ambas as artérias carótidas internas desviam-se medialmente e tocam-se próximo à linha media dentro do seio esfenoidal ou do osso esfenóide, incluindo a sela túrcica. Essa anomalia é particularmente importante, pois pode causar ou simular doença pituitária e ainda pode complicar uma cirurgia transesfenoidal. Relatamos um raro caso de artérias carótidas intracranianas "que se beijam" em mulher de 57 anos, a qual foi investigada por angiotomografia por quadro de cefaléia súbita. Discutimos a relevância clínica desse achado radiológico.

Hunter syndrome in an 11-year old girl on enzyme replacement therapy with idursulfase: brain magnetic resonance imaging features and evolution.

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Manara, Renzo; Rampazzo, Angelica; Cananzi, Mara; Salviati, Leonardo; Mardari, Rodica; Drigo, Paola; Tomanin, Rosella; Gasparotto, Nicoletta; Priante, Elena; Scarpa, Maurizio

2010-12-01

Mucopolysaccharidosis type II (MPS-II, Hunter disease) is a X-linked recessive disorder. Affected females are extremely rare, mostly due to skewed X chromosome inactivation. A few papers outline MPS-II brain magnetic resonance imaging (MRI) "gestalt" in males, but neuroradiological reports on females are still lacking. We present an 11-year-old girl affected by the severe form of MPS-II who was followed up over a time span of 8 years, focusing on clinical and brain MRI evolution. In the last 2.5 years, the patient has been treated with enzyme replacement therapy (ERT) with idursulfase (Elaprase™, Shire Human Genetic Therapies AB, Sweden). On brain and cervical MRI examination, abnormalities in our patient did not differ from those detected in male patients: J-shaped pituitary sella, enlargement of perivascular spaces, brain atrophy, mild T2-hyperintensity in the paratrigonal white matter, diffuse platyspondylia, and mild odontoid dysplasia with odontoid cup. Brain atrophy progressed despite ERT introduction, whereas perivascular space enlargement did not change significantly before and after ERT. Cognitive impairment worsened independently from the course of white matter abnormality. Despite a profound knowledge of genetic and biochemical aspects in MPS-II, neuroradiology is still poorly characterized, especially in female patients. Spinal and brain involvement and its natural course and evolution after ERT introduction still need to be clarified.

Gamma knife radiosurgery for secreting pituitary tumors

International Nuclear Information System (INIS)

Noren, G.; Jackson, I.M.D.; Chougule, P.; Zheng, Z.; Epstein, M.H.

1998-01-01

Transsphenoidal surgery usually represents first line treatment for pituitary adenomas with the aim of removing the tumor, decompressing the optic apparatus and, in secreting tumors, eliminating the hypersecretion. Gamma Knife radiosurgery is indicated for tumor remnants or recurrences in or above the sella including those invading the cavernous sinus and also as initial treatment in patients who are unable to tolerate an open surgical procedure and where medication has failed. In this study, the target definition was retrospectively studied and when necessary corrected in 10 acromegalic patients, 8 with Cushing's disease, and 12 with prolactinomas undergoing Gamma Knife radiosurgery. The dose plan was analyzed and the volume of the target covered by a minimum of 15, 20, 25, 30 and 35 Gy was estimated. A dose/volume profile for each treatment was created and correlated to the endocrinological and clinical outcome. Cure, according to strict endocrinological criteria, was seen in 6 of the acromegalic patients, in 2 of the patients with ACTH hypersecretion, and in 2 of the patients with prolactinomas. Analysis of these profiles, also for the patients with partial effect, show that a minimum radiation dose of 20 Gy may be adequate to eliminate the hypersecretion in acromegalic patients whereas a dose of at least 25 Gy may be required in patients with Cushing's disease and prolactinoma. (author)

Adult Multisystem Langerhans Cell Histiocytosis Presenting with Central Diabetes Insipidus Successfully Treated with Chemotherapy

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Jung-Eun Choi

2014-09-01

Full Text Available We report the rare case of an adult who was diagnosed with recurrent multisystem Langerhans cell histiocytosis (LCH involving the pituitary stalk and lung who present with central diabetes insipidus and was successfully treated with systemic steroids and chemotherapy. A 49-year-old man visited our hospital due to symptoms of polydipsia and polyuria that started 1 month prior. Two years prior to presentation, he underwent excision of right 6th and 7th rib lesions for the osteolytic lesion and chest pain, which were later confirmed to be LCH on pathology. After admission, the water deprivation test was done and the result indicated that he had central diabetes insipidus. Sella magnetic resonance imaging showed a mass on the pituitary stalk with loss of normal bright spot at the posterior lobe of the pituitary. Multiple patchy infiltrations were detected in both lung fields by computed tomography (CT. He was diagnosed with recurrent LCH and was subsequently treated with inhaled desmopressin, systemic steroids, vinblastine, and mercaptopurine. The pituitary mass disappeared after two months and both lungs were clear on chest CT after 11 months. Although clinical remission in multisystem LCH in adults is reportedly rare, our case of adult-onset multisystem LCH was treated successfully with systemic chemotherapy using prednisolone, vinblastine, and 6-mercaptopurine, which was well tolerated.

Quantification and detoxification of aflatoxin in food items

International Nuclear Information System (INIS)

Nisa, A.U.; Hina, S.; Ejaz, N.

2013-01-01

The present study was conducted to quantify and detoxify the antitoxins in food items. For this purpose, total 30 samples of food were collected. The samples were quantified using thin layer chromatography (TLC) for the presence of aflatoxin level in food items. Out of them aflatoxins were not found in 10 samples. Remaining 20 aflatoxins +ve samples were treated with various chemical solutions i.e. 0.1% HCl, 0.3%HCl, 0.5% HCI, 10% citric acid, 30% citric acid, 50% calcium hydroxide, 0.2 and 0.3% NaOCl, 96% ethanol and 99% acetone for detoxification. The aflatoxins were reduced to 55.1%, 90.9%, 28.08% and 80.0% in Super Sella rice, Super Basmati rice, Brown rice and White rice, respectively. The aflatoxin level was reduced in maize grain, damaged wheat, peanut, figs and dates upto 31.3 %, 64.3 %, 63.6%, 42.7% and 19.8%, respectively. Aflatoxins were detoxified in cereals Dal Chana, Dal Mash, Dal Masoor, turmeric (Haldi) and Nigela seeds (Kalwangi) upto 70.5%, 83.0%, 46.2%, 82.09% and 36.9%, respectively. Reduction of aflatoxins was carried out 39.7 %,7.l % 39.5% 82.0% and 62.0% in red chilli, makhana, corn flakes, desert (Kheer Mix) and pistachio. The significant results (p = 0.042) of detoxification of aflatoxins in food items were obtained from present study. (author)

Endoscopic treatment of trans-sellar trans-sphenoidal encephalocele associated with morning glory syndrome presenting with non-traumatic cerebrospinal fluid rhinorrhea.

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Sasani, M; Ozer, A F; Aydin, A L

2009-03-01

Basal encephaloceles are rare, accounting for about 1.5% of all encephaloceles. The trans-sellar trans-sphenoidal encephalocele variety is the rarest. Morning glory syndrome is often associated with basal encephalocele. Spontaneous cerebrospinal fluid (CSF) rhinorrheas are the least common of these, accounting for only 3% to 5% of all CSF rhinorrheas. The authors describe the outcome of a 10-year follow-up study of a 26-year-old male patient with a spontaneous CSF rhinorrhea occurring trans-sphenoidal encephalocele associated with bilateral morning glory syndrome that was treated with an endoscopic endonasal approach. Endoscopic exploration of the sella floor was performed and closed with abdomen fat packing and muscle fascia. The postoperative course was uneventful. A follow-up magnetic resonance (MR) image at 6 months postoperatively showed extension of encephalocele in the sphenoidal sinus, which was repaired. The patient had no further CSF rhinorrhea and showed no ophthalmologic changes over a follow-up period of over 10 years. Ophthalmologic findings such as strabismus, in association with anomalies of the optic nerve, should alert the physician to the possible presence of an unrecognized skull base midline defect and encephalocele before CSF leakage is seen. The authors believe that a surgeon who has equal confidence in performing the endoscopic endonasal and conventional microscopic trans-sphenoidal approaches should choose the less invasive surgery.

Preoperative clonidine use in trans-sphenoidal pituitary adenoma surgeries - a randomized controlled trial.

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Bajaj, Jitin; Mittal, Radhe Shyam; Sharma, Achal

2017-02-01

Pituitary masses are common lesions accounting for about 15-20% of all brain tumours. Oozing blood is an annoyance in microscopic sublabial trans-sphenoidal approach for these masses. There have been many ways of reducing the ooze, having their own pros and cons. To find out the efficacy and safety of clonidine in reducing blood loss in pituitary adenoma surgery through a randomized masked trial. It was a prospective randomized controlled trial done. Total 50 patients of pituitary adenomas were randomized into two groups. Group A (25 patients) was given 200 μg clonidine orally, while Group B (25 patients) was given placebo. Surgeon, anaesthesiologist and patient were blinded for the trial. Sublabial trans-septal trans-sphenoidal approach to sella and excision of mass was performed in each patient. Patients were studied for pre-, intra- and post-operative blood pressure and heart rate, pre- and post-operative imaging findings, intra-operative blood loss, bleeding grading by surgeon, surgeon's satisfaction about condition of specific part and quality of surgical field, operative time and extent of resection. Blood loss during the surgery, operative time and bleeding grading by the surgeon were found significantly less in the clonidine group, while quality of surgical field, condition of the specific part and extent of resection were found significantly better in the clonidine group (p value trans-sphenoidal microscopic pituitary adenoma surgeries.

Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves.

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Cho, Kwang Ho; Rodríguez-Vázquez, Jose Francisco; Han, Eui Hyeog; Verdugo-López, Samuel; Murakami, Gen; Cho, Baik Hwan

2010-09-20

Development of the meninges in and around the plica ventralis encephali has not been well documented. A distinct mesenchymal structure, the so-called plica ventralis encephali, is sandwiched by the fetal mesencephalic flexure. We histologically examined paraffin-embedded sections from 18 human embryos and fetuses at 6-12 weeks of gestation. In the loose tissues of the plica, the first meninx appeared as a narrow membrane along the oculomotor nerve at 7-8 weeks. Subsequently, the plica ventralis evolved into 3 parts: bilateral lateral mesenchymal condensations and a primitive membranous meninx extending between. Notably, the topographical anatomy of the oculomotor, trochlear and trigeminal nerves did not change: the oculomotor nerve ran along the rostral aspect of the membranous meninx, the trigeminal nerve ran along the caudal side of the lateral mesenchymal condensation, and the trochlear nerve remained embedded in the lateral condensation. Up to 9-10 weeks, the lateral mesenchymal condensations became tongue-like folds; i.e., the primitive form of the tentorium cerebelli, while the membranous meninx became the diaphragma sellae. The falx cerebri seemed to develop from the tongue-like folds. Overall, the final tentorium cerebelli corresponded to the regressed plica ventralis, while the parasellar area originated from the base of the plica and other tissues along the ventral aspects of the basisphenoid and basioccipital. Copyright © 2010 Elsevier GmbH. All rights reserved.

Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy

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Justin T. Dowdy MD

2014-01-01

Full Text Available Cerebrospinal fluid (CSF leak is the most commonly encountered perioperative complication in transsphenoidal surgery for pituitary lesions. Direct closure with a combination of autologous fat, local bone, and/or synthetic grafts remains the standard of care for leaks encountered at the time of surgery as well as postoperatively. The development of the vascularized nasoseptal flap as a closure technique has increased the surgeon’s capacity to correct even larger openings in the dura of the sella as well as widely exposed anterior skull base defects. Yet these advances in the technical nuances for management of post-transsphenoidal CSF leak are useless without the ability to recognize a CSF leak by physical examination, clinical history, biochemical testing, or radiographic assessment. Here, we report a case of a patient who developed a CSF leak 28 years after transsphenoidal surgery, precipitated by a robotic-assisted hysterectomy during which increased intra-abdominal pressure and steep Trendelenberg positioning were both factors. Given the remote nature of the patient’s transsphenoidal surgery and relative paucity of data regarding such a complication, the condition went unrecognized for several months. We review the available literature regarding risk and pathophysiology of CSF leak following abdominal surgery and propose the need for increased vigilance in identification of such occurrences with the increasing acceptance and popularity of minimally invasive abdominal and pelvic surgeries as standards in the field.

Intraoperative magnetic resonance imaging assessment of non-functioning pituitary adenomas during transsphenoidal surgery.

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Patel, Kunal S; Yao, Yong; Wang, Renzhi; Carter, Bob S; Chen, Clark C

2016-04-01

To review the utility of intraoperative imaging in facilitating maximal resection of non-functioning pituitary adenomas (NFAs). We performed an exhaustive MEDLINE search, which yielded 5598 articles. Upon careful review of these studies, 31 were pertinent to the issue of interest. Nine studies examined whether intraoperative MRI (iMRI) findings correlated with the presence of residual tumor on MRI taken 3 months after surgical resection. All studies using iMRI of >0.15T showed a ≥90% concordance between iMRI and 3-month post-operative MRI findings. 24 studies (22 iMRI and 2 intraoperative CT) examined whether intraoperative imaging improved the surgeon's ability to achieve a more complete resection. The resections were carried out under microscopic magnification in 17 studies and under endoscopic visualization in 7 studies. All studies support the value of intraoperative imaging in this regard, with improved resection in 15-83% of patients. Two studies examined whether iMRI (≥0.3T) improved visualization of residual NFA when compared to endoscopic visualization. Both studies demonstrated the value of iMRI in this regard, particularly when the tumor is located lateral of the sella, in the cavernous sinus, and in the suprasellar space. The currently available literature supports the utility of intraoperative imaging in facilitating increased NFA resection, without compromising safety.

Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography.

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Deng, Xuefei; Chen, Shijun; Bai, Ya; Song, Wen; Chen, Yongchao; Li, Dongxue; Han, Hui; Liu, Bin

2015-01-01

Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared. Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented. The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

Skeletal stability of patients undergoing maxillomandibular advancement for treatment of obstructive sleep apnea.

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Lee, Sang Hwa; Kaban, Leonard B; Lahey, Edward T

2015-04-01

To determine the long-term stability of maxillomandibular advancement (MMA) in patients with obstructive sleep apnea (OSA). This was a retrospective cohort study of patients who underwent MMA and genial tubercle advancement (GTA) for treatment of OSA. Patients were included if they 1) were older than 19 years; 2) had a confirmatory polysomnogram; 3) underwent a Le Fort I osteotomy, bilateral sagittal split osteotomies, and GTA; 4) had adequate radiographic documentation; and 5) at least 11 months of follow-up. Exclusion criteria included previous orthognathic or other maxillofacial surgery. Predictor variables were the presence of OSA treated by MMA, pre- and postoperative orthodontia or no orthodontia, length of follow-up, and magnitude of advancement. The outcome variable was the stability of MMA judged by clinical examination and cephalometric measurements. Standardized lateral cephalometric measurements were performed preoperatively (T0), immediately postoperatively (T1), and at the latest follow-up beyond 11 months (T2). Differences in cephalometric measurements were calculated between time points (T0 to T1 and T1 to T2) for the overall group and for patients who had orthodontia (group 1) and those who did not (group 2). A correlation analysis using length of follow-up and magnitude of advancement as predictor variables of stability was completed. For all analyses, a P value less than .05 was considered statistically significant. During the 9-year study period, 120 patients with OSA were evaluated and 112 had operative treatment; 25 patients specifically had MMA and GTA, met the inclusion criteria, and formed the study sample. The mean maxillary and mandibular advancements (T1 vs T0) were 9.48 mm (range, 1.6 to 15.2 mm) and 10.85 mm (range, 6.3 to 15.8 mm), respectively. From T1 to T2, no occlusal changes occurred. Changes in the subgroup analyses included a decrease in the angle formed by the sella, nasion, and A point (SNA) and the angle formed by the nasion

The eye as a window to rare endocrine disorders

Science.gov (United States)

Chopra, Rupali; Chander, Ashish; Jacob, Jubbin J.

2012-01-01

The human eye, as an organ, can offer critical clues to the diagnosis of various systemic illnesses. Ocular changes are common in various endocrine disorders such as diabetes mellitus and Graves’ disease. However there exist a large number of lesser known endocrine disorders where ocular involvement is significant. Awareness of these associations is the first step in the diagnosis and management of these complex patients. The rare syndromes involving the pituitary hypothalamic axis with significant ocular involvement include Septo-optic dysplasia, Kallman's syndrome, and Empty Sella syndrome all affecting the optic nerve at the optic chiasa. The syndromes involving the thyroid and parathyroid glands that have ocular manifestations and are rare include Mc Cune Albright syndrome wherein optic nerve decompression may occur due to fibrous dysplasia, primary hyperparathyroidism that may present as red eye due to scleritis and Ascher syndrome wherein ptosis occurs. Allgrove's syndrome, Cushing's disease, and Addison's disease are the rare endocrine syndromes discussed involving the adrenals and eye. Ocular involvement is also seen in gonadal syndromes such as Bardet Biedl, Turner's, Rothmund's, and Klinefelter's syndrome. This review also highlights the ocular manifestation of miscellaneous syndromes such as Werner's, Cockayne's, Wolfram's, Kearns Sayre's, and Autoimmune polyendocrine syndrome. The knowledge of these relatively uncommon endocrine disorders and their ocular manifestations will help an endocrinologist reach a diagnosis and will alert an ophthalmologist to seek specialty consultation of an endocrinologist when encountered with such cases. PMID:22629495

Comparative study of different osteotomy modalities in maxillary distraction osteogenesis for cleft lip and palate.

Science.gov (United States)

Yu, Hongbo; Wang, Xudong; Fang, Bing; Shen, Steve Guofang

2012-11-01

Conventional maxillary distraction osteogenesis and anterior maxillary segmental distraction were applied in the treatment of severe maxillary hypoplasia secondary to cleft clip and palate. The aim of the present study was to compare the difference between these 2 osteotomy modalities used for rigid external distraction. Ten patients with severe maxillary hypoplasia secondary to CLP were enrolled in our study. They were randomly divided into 2 groups. Conventional maxillary distraction osteogenesis was performed in 5 patients and anterior maxillary segmental distraction in 5 patients. The preoperative and postoperative lateral cephalograms were compared, and cephalometric analysis was performed. The independent sample t test was used to evaluate the differences between the 2 groups. All patients healed uneventfully, and the maxillae moved forward satisfactorily. The sella-nasion-point A angles, nasion-point A-Frankfort horizontal plane angles, overjets, and 0-meridian to subnasale distances had increased significantly after distraction osteogenesis. Significant differences were found in the changes in palatal length between the 2 groups (P maxillary segmental distraction group. No significant difference in the changes in palatopharyngeal depth or soft palatal length was found. With the ability of increasing the palatal and arch length, avoiding changes in palatopharyngeal depth, and preserving palatopharyngeal closure function, anterior maxillary segmental distraction has great value in the treatment of maxillary hypoplasia secondary to CLP. It is a promising and valuable technique in this potentially complicated procedure. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis.

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Muskens, Ivo S; Briceno, Vanessa; Ouwehand, Tom L; Castlen, Joseph P; Gormley, William B; Aglio, Linda S; Zamanipoor Najafabadi, Amir H; van Furth, Wouter R; Smith, Timothy R; Mekary, Rania A; Broekman, Marike L D

2018-01-01

In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes. A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values. Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results. In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.

Non-ablative fractional resurfacing in combination with topical tretinoin cream as a field treatment modality for multiple actinic keratosis: a pilot study and a review of other field treatment modalities.

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Prens, Sebastiaan P; de Vries, Karin; Neumann, H A Martino; Prens, Errol P

2013-06-01

Actinic keratoses (AK) are premalignant lesions occurring mainly in sun-damaged skin. Current topical treatment options for AK and photo-damaged skin such as liquid nitrogen and electrosurgery are not suitable for field treatment. Otherwise, therapies suitable for field treatment bring along considerable patient discomfort. Non-ablative fractional resurfacing has emerged as a logical treatment option especially for field treatment of AK. To evaluate the clinical efficacy of fractional laser therapy for clearing AK and improving skin quality. To compare patient friendliness of the "fractional" therapy with those reported for other field treatment modalities. Ten patients with Fitzpatrick skin type I to III with multiple AK and extensive sun-damaged skin, received 5-10 sessions with a 4-week interval using a 1550 nm Erbium-Glass Fractionated laser (Sellas, Korea). Four weeks and 24 weeks after the last treatment the clinical results were evaluated by an independent physician. The mean degree of improvement, in terms of reduction in the number of AK and improvement of skin texture, was 54% on a 4 point PGA scale, and persisted for approximately 6 months. The biggest advantage of fractional laser treatment, besides the eradication of AK and a clear rejuvenation effect, is the absence of "downtime". Fractional non-ablative resurfacing induces significant reduction in the number of AK and improves the skin quality. Also all patients preferred fractional laser therapy above other AK treatment modalities.

Correlation between displacement of optic chiasm on MR and visual symptomas and signs

International Nuclear Information System (INIS)

Kang, Eun Joo; Jang, Yun Hyung; Baik, Seung Kug; Ahn, Woo Hyun; Choi, Han Yong; Kim, Bong Gi

1994-01-01

MR is the most useful imaging method in evaluating the anatomic changes of the optic chiasm (OC). The purpose of this study is to investigate the relationship between the OC displacement and visual manifestations. We retrospectively reviewed 44 patients who showed displacement of OC on brain MR. The pattern of OC displacement was classified into 3 groups according to following criteria: group A included the patients with OC displacement only due to empty sella; group B represented the patients with OC displacement by a lesion and the border between the lesion and OC was distinct; and group C was the patients with OC displacement by a lesion and had a indistinct border or thinning of the OC. Visual symptoms and signs were noted in 12 patients and the most common sign was bitemporal hemianopsia. In group A (7 patients), the visual symptoms and signs were seen in only one patient (14%), in whom contracted visual fields persisted since previous pituitary apoplexy had developed. In group B (30 patients), the visual symptoms and signs were seen in 4 patients (13%) who had tumorous conditions except one case of cysticercosis. In group C (7 patients), the visual symptoms and signs were seen in all patients (100%). The more OC is compressed, the more the prevalence of visual symptoms and signs increases. However, there was no correlation between the occurrence of visual symptoms and the presence of OC displacement only without compression

Predictors of favorable soft tissue profile outcomes following Class II Twin-block treatment.

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Kim, Ji-Eun; Mah, Su-Jung; Kim, Tae-Woo; Kim, Su-Jung; Park, Ki-Ho; Kang, Yoon-Goo

2018-01-01

The aim of this study was to determine cephalometric factors that help predict favorable soft-tissue profile outcomes following treatment with the Class II Twin-block appliance. Pre- and post-treatment lateral cephalograms of 45 patients treated with the Class II Twin-block appliance were retrospectively analyzed. Profile silhouettes were drawn from the cephalograms and evaluated by three orthodontists in order to determine the extent of improvement. Samples were divided into a favorable group (upper 30% of visual analogue scale [VAS] scores, n = 14) and an unfavorable group (lower 30% of VAS scores, n = 14). Skeletal and soft-tissue measurements were performed on the cephalograms and an intergroup comparison was conducted. An independent t -test revealed that the following pre-treatment values were lower in the favorable group compared to the unfavorable group: lower incisor to mandibular plane angle, lower incisor to pogonion distance, point A-nasion-point B angle, sella-nasion line (SN) to maxillary plane angle, SN to mandibular plane angle, gonial angle, and symphysis inclination. The favorable group had a larger incisor inclination to occlusal plane. Moreover, the favorable group showed larger post-treatment changes in gonial angle, B point projection, and pogonion projection than did the unfavorable group. Class II malocclusion patients with a low divergent skeletal pattern and reduced lower incisor protrusions are likely to show more improvement in soft-tissue profile outcomes following Class II Twin-block treatment.

Transsphenoidal surgery assisted by a new guidance device: results of a series of 747 cases.

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Tao, Yang; Jian-wen, Gu; Yong-qin, Kuang; Li-bin, Yang; Hai-dong, Huang; Wen-tao, Yang; Xue-min, Xing

2011-10-01

The objective of this study is to report the efficacy and safety of microsurgical transsphenoidal surgery using a frame for sella guidance in a series of patients with untreated pituitary adenoma. In this study, seven hundred and forty-seven patients undergoing transsphenoidal resection of a pituitary adenoma involving use of the frame were included. Follow-up of twelve to one hundred months was performed in all patients. During the procedures using the frame, pituitary adenomas were fully exposed, and no cavernous sinus haemorrhage due to anteroposterior displacement or internal carotid artery lesion due to right-and-left deviation occurred. The duration of the surgical procedure ranged from 28 min to 87 min with a mean of 44 min. The most frequent tumour type was prolactin-secreting adenoma (32.4%), followed by clinically non-functioning adenoma (NFPA) (28.5%), growth hormone-secreting adenoma (25.0%), and adrenocorticotropin-secreting adenoma (13.7%). Normalisation of visual defects occurred in 226 (42.2%) of the 535 patients with visual disturbances. Normalisation of hormone occurred in 458 of 551 patients with endocrine-active tumour in the follow-up period. Two patients died as a consequence of surgery. The endonasal transsphenoidal technique is a safe, quick, and effective approach to pituitary adenomas. Our guidance frame allows the surgeon to open and close the wound rapidly, which avoids trajectory deviation and shortens the duration of the surgical procedure. Copyright © 2011 Elsevier B.V. All rights reserved.

Nasal and skull base anatomy of endoscopic endonasal transsphenoidal surgery with multi-detector computed tomography

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Hasegawa, Yuzo; Saeki, Naokatsu; Murai, Hisayuki; Horiguchi, Kentaro; Hanazawa, Toyoyuki; Okamoto, Miyoshi; Yanagawa, Noriyuki

2008-01-01

The endoscope is a new and highly useful instrument for transphenoidal surgery (TSS), and is generally used because of its minimally invasiveness. In addition, endoscopic transsphenoidal surgey (eTSS) has a potential for more radical tumor removal at the pituitary and the parasellar regions by wider visualization and more powerful illumination. To operate these regions safely, we need to know nasal and skull base anatomy under the endoscope which looks different from images under a microscope. In this paper, we demonstrated nasal and skull base anatomy with multi-detector computed tomography, which was performed in 23 recent patients with pituitary and parasellar legions. In the nasal legion, deviation of nasal septum and deviation of sphenoid ostium are important for endonasal approach of eTSS, and often determine the difficulty of surgery in the nasal cavity. Our study showed that deviation of nasal septum was seen in 26% of patients. Deviation of sphenoid ostium was 5.5±1.5 mm from the midline. The anatomy of sphenoid sinus plays a key role in our determination of the safety of a bony opening of the sella. In addition to sellar, presellar, and concha types, carotid prominence and optic prominence are important to determine the midline orientation. Development of carotid prominence was significantly related to the extent of lateral pneumatization of sphenoid sinus (P=0.0016). Reconstructed 3D-image of sphenoid sinus was very useful in visual understanding skull base anatomy. (author)

Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography.

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Xuefei Deng

Full Text Available Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV.Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared.Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented.The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

A case of stiff-person syndrome due to secondary adrenal insufficiency.

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Mizuno, Yuri; Yamaguchi, Hiroo; Uehara, Taira; Yamashita, Kenichiro; Yamasaki, Ryo; Kira, Jun-Ichi

2017-06-28

We report a case of flexion contractures in a patient's legs secondary to postpartum hypopituitarism. A 56-year-old woman presented with a 3-year history of worsening flexion contractures of the hips and knees. On admission, her hips and knees could not be extended, and she had muscle stiffness and tenderness to palpation of the lower extremities. We first suspected stiff-person syndrome or Isaacs' syndrome because of her muscle stiffness. However, multiple hormones did not respond to stimulation tests, and an MRI of the brain showed atrophy of the pituitary gland with an empty sella. A subsequent interview revealed that she had suffered a severe hemorrhage while delivering her third child. She was diagnosed with panhypopituitarism and started on cortisol replacement therapy. After 1 week of treatment with hydrocortisone (10 mg/day), her symptoms quickly improved. We then added 75 μg/day of thyroid hormone. During the course of her treatment, autoantibodies against VGKC complex were found to be weakly positive. However, we considered the antibodies to be unrelated to her disease, because her symptoms improved markedly with low-dose steroid treatment. There are a few reports describing flexion contractures of the legs in patients with primary and secondary adrenal insufficiency. As these symptoms are similar to those seen in stiff-person syndrome, adrenal and pituitary insufficiency should be taken into account to achieve the correct diagnosis and treatment in patients with flexion contractures and muscle stiffness.

MRI of normal pituitary glands and their surrounding structures

International Nuclear Information System (INIS)

Sato, Yoshiyuki

1991-01-01

Normal MRI appearances of the pituitary glands and their surrounding structures were evaluated in 332 patients without sellar and parasellar diseases. The height of the pituitary gland was maximum at 10-19 years of age reflecting hormonal activity. The width of the pituitary gland decreased, while that of the cavernous sinus increased with aging. This is probably due to atherosclerotic change of the internal carotid artery. Females younger than 30 years of age tended to show a convex upper surface of the pituitary gland and the displacement of the pituitary stalk was common after 50 years of age. Almost all of the anterior lobe of the pituitary gland showed isointensity relative to the pons or cerebral cortex and the majority (85.1%) of the posterior lobe showed hyperintensity. However, the anterior lobe in 2 newborns showed hyperintensity similar to the normal posterior lobe in adults. The posterior lobe was located off the midline in 19.1% of the subjects. One case of pars intermedia cyst was discovered among 14 subjects who were administered Gd-DTPA. The dural membrane between the pituitary gland and cavernous sinus was recognizable only in 8.6% on the right side and 7.5% on the left side. Primary empty sella was identified in 4.5%. Knowledge of the above normal ranges and variations of the pituitary gland and its surrounding structures is important in diagnosing sellar and parasellar lesions. (author) 52 refs

Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma.

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Davanzo, Justin R; Goyal, Neerav; Zacharia, Brad E

2018-02-01

This video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm. The link to the video can be found at: https://youtu.be/tahjHmrXhc4 .

Lymphocytic hypophysitis masquerading as pituitary adenoma

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Rajneesh Mittal

2012-01-01

Full Text Available Introduction: Pituitary hypophysitis (PH is characterized by pituitary infiltration of lymphocytes, macrophages, and plasma cells that could lead to loss of pituitary function. Hypophysitis may be autoimmune or secondary to systemic diseases or infections. Based on the histopathological findings PH is classified into lymphocytic, granulomatous, xanthomatous, mixed forms (lymphogranulomatous, xanthogranulomatous, necrotizing and Immunoglobulin- G4 (IgG4 plasmacytic types. Objective: To report a case of lymphocytic hypophysitis (LH. Case Report: A 15-year-old girl presented with history of headache, amenorrhea, and history of polyuria for past 4 months. Initial evaluation had suppressed follicular stimulating hormone (<0.01 mIU/ml, high prolactin levels (110.85 ng/ml and diabetes insipidus (DI. Magnetic resonance imaging of sella was suggestive of pituitary macroadenoma with partial compression over optic chiasma. Patient underwent surgical decompression. Yellowish firm tissue was evacuated and xanthochromic fluid was aspirated. Histopathology was suggestive of LH. She resumed her cycles postoperatively after 4 months, prolactin levels normalized, however, she continues to have DI and is on desmopressin spray. This case has been presented here for its rare presentation in an adolescent girl because it is mostly seen in young females and postpartum period and its unique presentation as an expanding pituitary mass with optic chiasma compression. Conclusion: Definitive diagnosis of LH is based on histopathological evaluation. Therapeutic approach should be based on the grade of suspicion and clinical manifestations of LH.

Value of pituitary MRI in children with short stat

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Huan ZHOU

2013-11-01

Full Text Available Objective　To explore the value of pituitary MRI in diagnosis of etiology and prognosis in children with short stature. Methods　The MRI data of 130 children with short stature admitted from Jan. to Dec. 2012 were retrospectively analyzed. Of the 130 children, 79 were males and 51 were females, aged 3 to 18 years with mean of 9.8 years. Results　Of the 130 children, 82 cases (63.1% were shown to have normal pituitary morphology and signal manifestation, and in 48 cases (36.9% pituitary morphology and signal manifestation were abnormal, and among them pituitary dysplasia was found in 30 cases, deficiency of bright signals in posterior pituitary lobe was found in 4 cases, in whom pituitary stalk deficiency was found in 2 cases. Pituitary microadenoma was found in 3 cases, and pituitary cystic lesions were found in 6 cases. Suprasellar cistern hernia was found in 4 cases, and empty sella was found in one case. The height of pituitary glands was 3.00-7.00mm in children with normal pituitary morphology and signal manifestation. Conclusion　MRI pituitary examination can clearly display the anatomy and the signal of the pituitary gland, therefore MR imaging is of important value in the diagnosis of the etiology diagnosis, treatment, and prognosis of children with short stature. It should be the preferred examination. DOI: 10.11855/j.issn.0577-7402.2013.11.008

Significant Improvement in Chronic Persistent Headaches Caused by Small Rathke Cleft Cysts After Transsphenoidal Surgery.

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Fukui, Issei; Hayashi, Yasuhiko; Kita, Daisuke; Sasagawa, Yasuo; Oishi, Masahiro; Tachibana, Osamu; Nakada, Mitsutoshi

2017-03-01

Rathke cleft cysts (RCC) usually are asymptomatic and can be observed via the use of conservative methods. Some patients with RCCs, however, have severe headaches even if they are small enough to be confined to the sella, and these small RCCs seldom have been discussed. This study presents an investigation into clinical characteristics of small RCCs associated with severe headaches, demonstrating efficacy and safety of endoscopic transsphenoidal surgery (ETSS) to relieve headaches. In this study, 13 patients with small RCCs (maximum diameter HIT-6) score was calculated both pre- and postoperatively to evaluate headache severity. All patients complained of severe headaches, which disturbed their daily life. Most headaches were nonpulsating and localized in the frontal area. Characteristically, 6 patients (46%) experienced severe headaches with sudden onset that continued chronically. HIT-6 score was 64 on average, meaning headaches affected daily life severely. After surgical decompression of the cyst, headache in all of the patients improved dramatically and HIT-6 score decreased significantly to 37, suggesting that headaches were diminished. No newly developed deficiencies of the anterior pituitary lobe function were detected. Postoperative occurrence of diabetes insipidus was found in 2 patients, both of which were transient. No recurring cysts were found. Severe headaches can develop from small RCCs. In the present study, ETSS was performed on such patients effectively and safely to relieve their headaches. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical profile, evaluation, management and visual outcome of idiopathic intracranial hypertension in a neuro-ophthalmology clinic of a tertiary referral ophthalmic center in India

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Ambika S

2010-01-01

Full Text Available Aim: To discuss the clinical features and management of patients who presented with optic disc edema and had features of presumed idiopathic intracranial hypertension (IIH. Materials and Methods: Case series of all patients diagnosed to have IIH from January 2000 to December 2003 in the neuro-ophthalmology clinic of a tertiary referral ophthalmic institution, were retrospectively analyzed. Analysis was done for 50/106 patients who fulfilled modified Dandy′s criteria and had optic disc edema and a minimal follow-up period of two years. Results: Most (40/50, 80% of the patients were females and the mean age of presentation for all the 50 patients was 32.89 years. Chief complaints were headache in 38 (76% patients, 24 (48% patients had transient visual obscuration, 24 (48% patients had reduced vision, 15 (30% patients had nausea, vomiting, 4 (8% patients had diplopia. Bilateral disc edema was seen in 46 (92% patients and unilateral disc edema in 4 (8% patients. 60 eyes had enlarged blind spot as the common visual field defect. Neuroimaging revealed prominent perioptic CSF spaces in 14 patients and empty sella in three patients. CSF opening pressure was 250-350 mm H2O (water in 39 patients and was > 350 mm H2O in 11 patients. Medical treatment was started for all patients; whereas 35 [70%] patients responded, 15 [30%] patients had to undergo LP shunt.

Preoperative Visualization of Cranial Nerves in Skull Base Tumor Surgery Using Diffusion Tensor Imaging Technology.

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Ma, Jun; Su, Shaobo; Yue, Shuyuan; Zhao, Yan; Li, Yonggang; Chen, Xiaochen; Ma, Hui

2016-01-01

To visualize cranial nerves (CNs) using diffusion tensor imaging (DTI) with special parameters. This study also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. 3T magnetic resonance imaging scans including 3D-FSPGR, FIESTA, and DTI were used to collect information from 18 patients with skull base tumor. DTI data were integrated into the 3D slicer for fiber tracking and overlapped anatomic images to determine course of nerves. 3D reconstruction of tumors was achieved to perform neighboring, encasing, and invading relationship between lesion and nerves. Optic pathway including the optic chiasm could be traced in cases of tuberculum sellae meningioma and hypophysoma (pituitary tumor). The oculomotor nerve, from the interpeduncular fossa out of the brain stem to supraorbital fissure, was clearly visible in parasellar meningioma cases. Meanwhile, cisternal parts of trigeminal nerve and abducens nerve, facial nerve were also imaged well in vestibular schwannomas and petroclival meningioma cases. The 3D-spatial relationship between CNs and skull base tumor estimated preoperatively by tumor modeling and tractography corresponded to the results determined during surgery. Supported by DTI and 3D slicer, preoperative 3D reconstruction of most CNs related to skull base tumor is feasible in pathological circumstances. We consider DTI Technology to be a useful tool for predicting the course and location of most CNs, and syntopy between them and skull base tumor.

Anterior pituitary failure (panhypopituitarism) with balanced chromosome translocation 46,XY,t(11;22)(q24;q13).

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Yang, C Y; Chou, C W; Chen, S Y; Cheng, H M

2001-04-01

Hypopituitarism is the clinical syndrome that results from failure of the anterior pituitary gland to produce its hormones. Hypopituitarism can result from: (1) intrinsic or primary pituitary disease; (2) intrinsic hypothalamic or secondary pituitary disease; or (3) extrinsic extrasellar or parasellar disease. The etiologies of primary hypopituitarism are miscellaneous. The dominant clinical picture of hypopituitarism in the adult is that of hypogonadism. Reports have associated hypopituitarism with anti-pituitary-antibodies, hereditary syndrome and chromosome defects, but hypopituitarism has rarely been associated with balanced chromosome translocation (11;22)(q24;q13). Here, we describe a case of anterior pituitary failure with balanced chromosome translocation. A 19-year-old Chinese teenager presented with failure of pubertal development and sexual infantilism. On examination, the patient had the classic appearance of hypogonadism. Endocrine studies and three combined pituitary function tests revealed panhypopituitarism. A chromosomal study revealed 46,XY,t(11;22)(q24;q13), a balanced translocation between 11q24 and 22q13. Chest films showed delayed fusion of bilateral humeral head epiphyses and bilateral acromions. Scrotal sonography revealed testes were small bilaterally. Magnetic resonance imaging (MRI) of the sella revealed pituitary dwarfism. The patient received 19 months replacement therapy, including steroids (prednisolone 5 mg each day), L-thyroxine (Eltroxin 100 ug each day), and testosterone enanthate 250 mg every two weeks. His height increased 4 cm with secondary sexual characteristics developed, and muscle power increased.

Clinical importance of the basal cavernous sinuses and cavernous carotid arteries relative to the pituitary gland and macroadenomas: quantitative analysis of the complete anatomy.

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Yilmazlar, Selcuk; Kocaeli, Hasan; Eyigor, Ozhan; Hakyemez, Bahattin; Korfali, Ender

2008-08-01

It is unusual to encounter hemorrhagic complications caused by arterial or venous damage during TSS. Problems with these structures can lead to permanent disability or death. Our aim was to quantitatively analyze anatomical and radiologic relationships among the BCS, the CCA, and the pituitary gland, as these structures are accessed during TSS. Forty-nine formaldehyde-fixed, sellar-parasellar tissue blocks from adult cadavers were used to simulate accessing the BCSs via TSS. In each specimen, size of the pituitary gland and specific characteristics of each BCS and the horizontal segment of each CCA were recorded. Nine other specimens were used for histologic investigation and microanatomical measurements. To attest correlation between clinical data and cadaveric measurements, coronal MRI scans of 22 healthy adults as well as of 28 patients with macroadenomas were analyzed. In cadaveric specimens, distances between both CCAs in the BCS were 17.1 +/- 4.0 mm anteriorly, 20.3 +/- 4.2 mm medially, and 18.8 +/- 4.6 mm posteriorly. In this study, the anterior medial space of the BCS was dominant in 12 specimens on the right side and in 5 specimens on the left; the posterior medial space of the BCS was dominant in 23 specimens on the right side and in 9 specimens on the left side. The right medial BCS was dominant in 35 specimens. On histologic coronal sections, some part of the carotid artery's (CA's) diameter was located below the line passing from the basal dural layer ranging from 5.3% to 65.4%. In normal-sella images, distances between both CCAs were 15.4 +/- 1.8 mm anteriorly, 16.0 +/- 2.8 mm medially, 16.2 +/- 3.4 mm posteriorly. On coronal normal-sella images, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 16.4% to 66.7%. In macroadenomas, distances between both CCAs were 22.0 +/- 3.6 mm anteriorly, 21.5 +/- 3.8 mm medially, and 20.7.2 +/- 3.7 mm posteriorly . On coronal images, in only 6 of 28

A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors.

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Graffeo, Christopher S; Dietrich, August R; Grobelny, Bartosz; Zhang, Meng; Goldberg, Judith D; Golfinos, John G; Lebowitz, Richard; Kleinberg, David; Placantonakis, Dimitris G

2014-08-01

Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations.

Superior interhemispheric approach for midline meningioma from the anterior cranial base.

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Lévêque, S; Derrey, S; Martinaud, O; Gérardin, E; Langlois, O; Fréger, P; Hannequin, D; Castel, H; Proust, F

2011-07-01

For suprasellar meningioma, the fronto-basal exposure is considered the standard approach. The superior interhemispheric (IH) approach is less described in the literature. To assess the surgical complications, functional outcome (visual, olfaction), morbidity and mortality rates and late recurrence, after resection by superior IH approach of midline skull base meningioma. Between 1998 and 2008, 52 consecutive patients with midline meningioma on the anterior portion of the skull base (mean age: 63.8 ± 13.1; sex ratio F/M: 3.7) were operated on via the superior IH approach. After a mean follow-up of 56.9 ± 32.9 months, an independent neurosurgeon proposed a prospective examination of functional outcome to each patient, as well as a visual and olfactory function assessment. Fifty-two patients were divided into a group with olfactory groove meningioma (n=34) and another with tuberculum sellae meningioma (n=18). The outcome was characterized by postoperative complications in 13 patients (25%), mortality rate in two (3.8%) and long-term morbidity at in 17 (37%) of 50 surviving patients. Based on multivariate analysis, no prognosis factor was significant as regards the favorable outcome. The mean postoperative KPS score (86.6 ± 9.4) was significantly improved. However, dysexecutive syndrome was observed in four patients (8%), hyposmia-anosmia in 34 (68%) and visual acuity deteriorated in one (2%). The superior IH approach could be considered a safe anteriorly orientated midline approach for removal OGM and TSM meningioma. Copyright © 2011. Published by Elsevier Masson SAS.

Frontobasal Midline Meningiomas: Is It Right To Shed Doubt on the Transcranial Approaches? Updates and Review of the Literature.

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Ruggeri, Andrea Gennaro; Cappelletti, Martina; Fazzolari, Benedetta; Marotta, Nicola; Delfini, Roberto

2016-04-01

Traditionally, the surgical removal of tuberculum sellae meningioma (TSM) and olfactory groove meningioma (OGM) requires transcranial approaches and microsurgical techniques, but in the last decade endoscopic expanded endonasal approaches have been introduced: transcribriform for OGMs and transtuberculum-transplanum for TSM. A comparative analysis of the literature concerning the two types of surgical treatment of OGMs and TSM is, however, difficult. We conducted a literature search using the PubMed database to compare data for endoscopic and microsurgical techniques in the literature. We also conducted a retrospective analysis of selected cases from our series presenting favorable characteristics for an endoscopic approach, based on the criteria of operability of these lesions as generally accepted in the literature, and we compared the results obtained in these patients with those in the endoscopic literature. We believe that making the sample more homogeneous, the difference between microsurgical technique and endoscopic technique is no longer so striking. A greater radical removal rate, a reduced incidence of cerebrospinal fluid fistula and, especially, the possibility of removing lesions of any size are advantages of transcranial surgery; a higher percentage of improvement in visual outcome and a lower risk of a worsening of a pre-existing deficit or onset of a new deficit are advantages of the endoscopic technique. At present, the microsurgical technique is still the gold standard for the removal of the anterior cranial fossa meningiomas of all sizes, and the endoscopic technique remains a second option in certain cases. Copyright © 2016 Elsevier Inc. All rights reserved.

Management of Severely Atrophic Maxilla in Ectrodactyly Ectodermal Dysplasia-cleft Syndrome.

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Rachmiel, Adi; Turgeman, Shahar; Emodi, Omri; Aizenbud, Dror; Shilo, Dekel

2018-02-01

Ectrodactyly ectodermal dysplasia-cleft syndrome is a rare genetic syndrome with an incidence of 1/90,000 live births, characterized by cleft lip and palate, severely hypoplastic maxilla, and hypodontia. Patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome suffer from a severely hypoplastic maxilla that is highly difficult to treat using traditional orthognathic methods. In this study, we propose using distraction osteogenesis to achieve a major advancement while maintaining good stability and minimal relapse. To our knowledge, this is the first description of patients with this syndrome treated using distraction osteogenesis. Five patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome were included in the study. All patients had been operated on according to the well-established protocol of cleft lip and palate reconstruction before maxillary distraction osteogenesis. Hard and soft-tissue changes were evaluated by cone beam computed tomography and lateral cephalograms before distraction osteogenesis (T1), at the postdistraction point (T2) and after 1 year of follow-up (T3). Examination revealed marked maxillary advancement in all our patients with a significant mean difference in hard tissue parameters (condylion to A point = 18 mm; nasion-sella line to A point = 15.2 degrees) and a notable improvement in facial convexity (20.9 degrees). One year follow-up measurements demonstrated mild relapse rates of 6% in the horizontal plane. We conclude that despite the challenging anatomic and physiological features of ectrodactyly ectodermal dysplasia-cleft patients, by enhancing current surgical techniques, there is promising potential for improved patient outcomes, achieving normognathic facial appearance with implant supported rehabilitation.

Radiation Therapy for Pituitary Adenoma - Changes in Endocrine Function after Treatment-

International Nuclear Information System (INIS)

Yoon, Sei Chul; Jang, Hong Suck; Kim, Song Hwan; Shinn, Kyung Sub; Bahk, Yong Whee; Son, Ho Young; Kang, Joon Ki

1991-01-01

Seventy four patients with pituitary adenoma received radiation therapy(RT) on the pituitary area using 6 MV linear accelerator during the past 7 years at the Division of Radiation Therapy, Kangnam St. mary's hospital, Catholic University Medical College. Thirty nine were men and 35 were women. The age ranged from 7 to 65 years with the mean being 37 years. Sixty five (88%) patients were treated postoperatively and 9(12%) primary RT. To evaluate the effects of RT, we analyzed the series of endocrinologic studies with prolactin(PRL), growth hormone(GH), adrenocortiotrophic hormone (ACTH), leuteinizing hormone (LH), follicular stimulating hormone(FSH) and thyroid stimulating hormone(TSH) etc after RT. All but one with Nelson's syndrome showed abnormal neuroradiologic changes in the sella turica with invasive tumor mass around supra-and/or parasella area. The patients were classified as 23(29%) prolactinomas and 20 (26%) growth hormone (GH) secreting tumors, and 6(8%) ACTH secreting ones consisting of 4 Cushing's disease and 2 Nelson's syndrome. Twenty nine(37%) had nonfunctioning tumor and four (5%) of those secreting pituitary tumors were mixed PRL-GH secreting tumors. The hormonal level in 15(65%) of 23 PRL and 3(15%) of 20 GH secreting tumors returned to normal by 2 to 3 years after RT, but five PRL and five GH secreting tumors showed high hormonal level requiring bromocriptine medication. Endocrinologic insufficiency developed by 3 years after RT in 5 of 7 panhypopituitarisms, 4 of seven hypothyroidisms and one of two hypogonadisms, respectively, Fifteen(20%) patients were lost to follow up after RT

The eye as a window to rare endocrine disorders

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Rupali Chopra

2012-01-01

Full Text Available The human eye, as an organ, can offer critical clues to the diagnosis of various systemic illnesses. Ocular changes are common in various endocrine disorders such as diabetes mellitus and Graves′ disease. However there exist a large number of lesser known endocrine disorders where ocular involvement is significant. Awareness of these associations is the first step in the diagnosis and management of these complex patients. The rare syndromes involving the pituitary hypothalamic axis with significant ocular involvement include Septo-optic dysplasia, Kallman′s syndrome, and Empty Sella syndrome all affecting the optic nerve at the optic chiasa. The syndromes involving the thyroid and parathyroid glands that have ocular manifestations and are rare include Mc Cune Albright syndrome wherein optic nerve decompression may occur due to fibrous dysplasia, primary hyperparathyroidism that may present as red eye due to scleritis and Ascher syndrome wherein ptosis occurs. Allgrove′s syndrome, Cushing′s disease, and Addison′s disease are the rare endocrine syndromes discussed involving the adrenals and eye. Ocular involvement is also seen in gonadal syndromes such as Bardet Biedl, Turner′s, Rothmund′s, and Klinefelter′s syndrome. This review also highlights the ocular manifestation of miscellaneous syndromes such as Werner′s, Cockayne′s, Wolfram′s, Kearns Sayre′s, and Autoimmune polyendocrine syndrome. The knowledge of these relatively uncommon endocrine disorders and their ocular manifestations will help an endocrinologist reach a diagnosis and will alert an ophthalmologist to seek specialty consultation of an endocrinologist when encountered with such cases.

Hybrid Microscopic-Endoscopic Surgery for Craniopharyngioma in Neurosurgical Suite: Technical Notes.

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Ichikawa, Tomotsugu; Otani, Yoshihiro; Ishida, Joji; Fujii, Kentaro; Kurozumi, Kazuhiko; Ono, Shigeki; Date, Isao

2016-01-01

The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in a neurosurgical suite. Four children with craniopharyngiomas underwent microscopic resection. When the neurosurgeon was confident that most of the visible tumor was removed but was suspicious of residual tumor within the blind spot, he or she used an integrated endoscope-holder system to inspect and remove any residual tumor. Two ceiling monitors were mounted side by side in front of the surgeon to display both microscopic and endoscopic views and to view both monitors simultaneously. Surgery was performed in all patients via the frontobasal interhemispheric approach. Residual tumors were observed in the sella (2 patients), on the ventral surface of the chiasm and optic nerve (1 patient), and in the third ventricle (1 patient) and were resected to achieve total resection. Postoperatively, visual function was improved in 2 patients and none exhibited deterioration related to the surgery. Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of normal brain CT scan in Korean

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Lee, Y. H.; Suh, J. H.; Park, C. Y. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1981-06-15

The safety of procedure combined with wealth of information have resulted in rapid acceptance of CT as a practical and reliable neurodignostic technique. To understand the alternation in tissue density and associated displacement and distortion caused by pathologic lesion in CT, it is necessary to have clear understanding of normal anatomical landmark. For the purpose of establishing normative criteria in Korean for comparative diagnosis, 500 normal CT scan without neurologic sign were studied. The brief results are follows; 1. Among many ventricular index measured for lateral ventricle, the bifrontal CVI is more sensitive and easily determined. Ventricular size increased with age, especially after 6th decade but no difference with sex. 2. Mean width of third ventricle is 5 mm ({+-} 0.3), more wider in male (male; 5.2 mm, female; 4.5 mm) and increased with age. 2. Mean width of fourth ventricle is 13 mm ({+-} 1.3), without difference in age and sex. The shape of ventricle is variable form of triangle. The position of ventricle relative to Twining's line can be determined, so ratio of distance from tuberculum sellae to center of fourth ventricle to Twining's line is between 0.46-0.52. 4. Suprasellar cistern is visible in 89.7% of scan and shape of cistern is found to be pentagonal (73.3%), hexagonal (23.0%) and tetragonal (3.7%). 5. Choroid plexus can be identified in 90% and asymmetrical in 4%. 45% of identified choroid plexus can be visible on scan without contrast enhancement, and more frequently visible in older age.

Dynamic computed tomography for the diagnosis of pituitary microadenoma, 1

International Nuclear Information System (INIS)

Tsuchiya, Toshiaki

1992-01-01

The purpose of this paper is to evaluate the dynamic CT findings on the normal pituitary gland. Dynamic CT scan was studied in 20 normal pituitary glands. In the anterior lobe, initially the secondary capillary bed ('tuft' by Bonneville) appeared as a high density area located in the midline, beneath the upper surface of the anterior lobe. Subsequently the high density area, located in the secondary capillary bed, spreaded centrifugally into the anterior lobe. Finally, the entire anterior lobe became a homogeneously high density area. Three patterns of the time-density curve were observed in the anterior lobe. Type 1, observed in the midline, beneath the upper surface of the anterior lobe, was a vascular pattern. It corresponded to the tuft topographically. Compared with the other venous system, the peak of the type 1 somewhat delayed. It is considered due to a slower circulation in the hypophyseal portal system. Type 2, observed just below the tuft, represented the extravasation of contrast material in a highly vascular tissue (hypervascular extravasation pattern). Type 3, observed at the bottom of the anterior lobe, represented the extravasation of contrast material in a less vascular tissue (oligovascular extravasation pattern). The posterior lobe appeared as a high density area, in the midline, close to the dorsum sellae. The time-density curve of the posterior lobe had the vascular pattern with the peak time which coincides with arterial one. The ordinary artery-capillary-venouse circulatory system and the blood-brain-barrier in the posterior lobe well explain these facts. (author)

A Roentgenocephalometric Study for the Acceptable Profile in Korean Adults

International Nuclear Information System (INIS)

Lee, You Dong; Lee, Sang Rae

1990-01-01

The primary objective of this study was to analyze the hard and soft tissue profile and comparison of the both sexes in Korean adults using roentgenocephalometry. The subjects were 122 males and 116 females from 18 to 22 years of age selected on the basis of their excellent occlusion and harmonious profile. It was an investigation about the interrelationships in the angles which consisted of Frankfort horizontal plane (FH plane), Sella Nasion plane (SN plane), Nasal floor plane (NF plane) and Mandibular plane (Md plane) as reference planes, and of the axial inclinations of the upper anterior tooth to Nasal floor plane (NF Plane) and of the lower anterior tooth to Mandibular plane (Md Plane). Among the 14 categories established on the soft tissue landmarks, the 6 categories were studied for the relationship to Frankfort horizontal plane (FH Plane), and the 8 categories were studied for the soft tissue contour. The results were as follows: 1. Among 8 measured angles in the hard tissue, the angle of FH-Md, NF-Md and N-Md were greater in females than in males. 2. The axial inclinations of the anterior teeth to NF Plane and Md plane were slightly greater in males than in females. 3. Among 14 measured angles in the soft tissue, the angles of G-Sn-P and E-Pog-Sn were greater in males, and FH-G-Sn, G·Sn-Sn·Pog and Pog-Sn-P were greater in females. 4. In males, the variability of measured values in both lips region were high.

The surgical treatment strategy and results of parasellar meningiomas in the era of radiosurgery

International Nuclear Information System (INIS)

Iwai, Yoshiyasu; Yamanaka, Kazuhiro; Morikawa, Toshie; Ishiguro, Tomoya; Honda, Yuji; Matsuzaka, Yasuhiro; Komiyama, Masaki; Yasui, Toshihiro

2003-01-01

We evaluated the surgical treatment results of parasellar meningiomas in the era of radiosurgery. We treated 24 patients of parasellar meningiomas surgically. The median age was 60 yrs (ranging from 29 to 82 yrs). The most common tumor location was the sphenoid ridge in 12 patients and the tuberculum sellae in 7 patients. The pterional approach using fronto-temporal craniotomy was performed for all patients. The residual or recurrent tumors were treated by gamma knife radiosurgery (GKS). We are able to follow up these cases for a median of 3.8 yrs (ranging from 1 to 8 yrs) after the operations. The radicality of tumor resection was Simpson grade II in 13 patients (54%), grade III in 3 patients (13%) and grade IV in 7 patients (33%). Clinical improvement was achieved in 81% of the patients. Of the patients who had visual disturbance preoperatively, 8 patients (73%) showed improvement, but 3 patients suffered deterioration postoperatively. None of the patients died. One patient suffered transient memory disturbance and one patient suffered mild facial numbness postoperatively. Boost radiosurgery for the residual tumors was performed for six patients and tumor growth control was able to be achieved in all patients, with a median of 3.1 years follow-up period (ranging from 0.5 to 6 yrs). Five patients with tumor regrowth or recurrence were treated by GKS. We recommend fronto-temporal craniotomy with nonradical resection for parasellar meningiomas and radiosurgery for residual and recurrent tumors. This strategy will achieve good functional outcome with long-term tumor growth control. (author)

Anatomic Dissection of Arachnoid Membranes Encircling the Pituitary Stalk on Fresh, Non-Formalin-Fixed Specimens: Anatomoradiologic Correlations and Clinical Applications in Craniopharyngioma Surgery.

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Ciappetta, Pasqualino; Pescatori, Lorenzo

2017-12-01

The anatomy of the arachnoid membranes and cisternal spaces around the pituitary stalk has not been yet exhaustively described and understood. In this study, we performed a detailed anatomic study on fresh, non-formalin-fixed cadavers of the arachnoid membranes encircling the pituitary stalk and correlate our anatomic findings with magnetic resonance imaging (MRI). Ten fresh, non-formalin-fixed, non-silicon-injected adult cadaveric heads were analyzed in this study. The membrane and cisterns that were studied for our study were as follows: 1) the diaphragma sellae and its dural components; 2) the basal arachnoid membrane; 3) the Liliequist membrane with its diencephalic and mesencephalic portion; 4) the medial carotid membrane; 5) the chiasmatic cistern; and 6) the pituitary stalk. MRI examinations of the sellar region were performed in 15 healthy volunteers (9 men, mean age 40 years; and 6 women mean age, 37 years) to visualize the arachnoid membrane encircling the pituitary stalk. MRI examinations were performed with a 3-T unit. A 3-dimensional constructive interference in steady state pulse magnetic resonance sequence was used. All the membranes examined were visualized clearly in all the dissections performed. Their 3-dimensional organization around the pituitary stalk was clarified and confirmed by MRI. Our study gives a detailed description of the pituitary stalk arachnoid sheets on fresh, non-formalin-fixed cadavers. This technique allowed us to clearly identify a funnel-shaped arachnoid collar encircling the pituitary stalk and delimiting a distinct cisternal space belonging to the stalk itself. Copyright © 2017 Elsevier Inc. All rights reserved.

Can commonly used profile planes be used to evaluate changes in lower lip position?

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Buschang, Peter H; Fretty, Kimberly; Campbell, Phillip M

2011-07-01

To determine the validity of five profile planes commonly used to describe the horizontal changes of the lower lip during orthodontic treatment. Pretreatment and posttreatment cephalograms of 79 patients (12.4 ± 2.8 years of age) were evaluated. Lower lip (labrale inferiorus) changes over time were measured relative to the Rickett's E-line, Steiner's S1-line, Burstone's B-line, Sushner's S2-line, and Holdaway's H-line. As an independent measure of actual horizontal lip changes, the labrale inferiorus was measured relative to a stable reference plane registered on the sella and oriented on the SN-7°. The lower lip actually moved anteriorly 2.35 ± 3.35 mm during orthodontic treatment; the five profile planes indicated that the lower lip moved to a more retrusive, posterior position. The five profile planes also showed no statistically significant sex differences in terms of the treatment changes that occurred, while the actual lip changes showed that males exhibited significantly greater changes than females. Actual treatment changes showed that the lower lip moved to a more protrusive position with nonextraction than with extraction treatments, changes that were not evident based on the five profile lines. While lip changes based on the five profile planes demonstrated moderately high to high intercorrelations ranging from 0.81 to 0.97, they showed only weak correlations (r planes measured similar aspects of positional change, none of them closely reflected the actual lower lip changes that occurred. These planes should not be used to measure changes in lip position that occur during treatment.

Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas.

Science.gov (United States)

Lee, Han Bee; Kim, Sung Tae; Kim, Hyung-Jin; Kim, Keon Ha; Jeon, Pyoung; Byun, Hong Sik; Choi, Jin Wook

2012-03-01

Does dynamic gadolinium-enhanced imaging with simultaneous acquisition of coronal and sagittal planes improve diagnostic accuracy of pituitary microadenomas compared with coronal images alone? Fifty-six patients underwent 3-T sella MRI including dynamic simultaneous acquisition of coronal and sagittal planes after gadolinium injection. According to conspicuity, lesions were divided into four scores (0, no; 1, possible; 2, probable; 3, definite delayed enhancing lesion). Additional information on supplementary sagittal images compared with coronal ones was evaluated with a 4-point score (0, no; 1, possible; 2, probable; 3, definite additional information). Accuracy of tumour detection was calculated. Average scores for lesion detection of a combination of two planes, coronal, and sagittal images were 2.59, 2.32, and 2.18. 6/10 lesions negative on coronal images were detected on sagittal ones. Accuracy of a combination of two planes, of coronal and of sagittal images was 92.86%, 82.14% and 75%. Six patients had probable or definite additional information on supplementary sagittal images compared with coronal ones alone (10.71%). Dynamic MRI with combined coronal and sagittal planes was more accurate for detection of pituitary microadenomas than routinely used coronal images. Simultaneous dynamic enhanced acquisition can make study time fast and costs low. We present a new dynamic MRI technique for evaluating pituitary microadenomas • This technique provides simultaneous acquisition of contrast enhanced coronal and sagittal images. • This technique makes the diagnosis more accurate and reduces the examination time. • Such MR imaging only requires one single bolus of contrast agent.

Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism.

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Hirsch, Dania; Benbassat, Carlos; Toledano, Yoel; S'chigol, Irena; Tsvetov, Gloria; Shraga-Slutzky, Ilana; Eizenberg, Yoav; Shimon, Ilan

2015-08-01

Data on pituitary imaging in adult male patients presenting with hypogonadotrophic hypogonadism (HH) and no known pituitary disease are scarce. To assess the usefulness of pituitary imaging in the evaluation of men presenting with HH after excluding known pituitary disorders and hyperprolactinemia. A historical prospective cohort of males with HH. Men who presented for endocrine evaluation from 2011 to 2014 with testosterone levels pituitary disease. Seventy-five men were included in the analysis. Their mean age and BMI were 53.4 ± 14.8 years and 30.7 ± 5.2 kg/m2, respectively. Mean total testosterone, LH, and FSH were 6.2 ± 1.7 nmol/L, 3.4 ± 2 and 4.7 ± 3.1 mIU/L, respectively. Prolactin level within the normal range was obtained in all men (mean 161 ± 61, range 41-347 mIU/L). Sixty-two men had pituitary MRI and 13 performed CT. In 61 (81.3%) men pituitary imaging was normal. Microadenoma was found in 8 (10.7%), empty sella and thickened pituitary stalk in one patient (1.3%) each. In other four patients (5.3%) a small or mildly asymmetric pituitary gland was noted. No correlation was found between testosterone level and the presence of pituitary anomalies. This study suggests that the use of routine hypothalamic-pituitary imaging in the evaluation of IHH, in the absence of clinical characteristics of other hormonal loss or sellar compression symptoms, will not increase the diagnostic yield of sellar structural abnormalities over that reported in the general population.

Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

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Y R Yadav

2012-01-01

Full Text Available Endoscopic endonasal trans-sphenoid surgery (EETS is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

Evaluation of normal brain CT scan in Koreans

International Nuclear Information System (INIS)

Lee, Y. H.; Suh, J. H.; Park, C. Y.

1981-01-01

The safety of procedure combined with wealth of information have resulted in rapid acceptance of CT as a practical and reliable neurodiagnostic technique. To understand the alternation in tissue density and associated displacement and distortion caused by pathologic lesion in CT, it is necessary to have clear understanding of normal anatomical landmark. For the purpose of establishing normartive criteria in Koreans for comparative diagnosis, 500 normal CT scan without neurologic sign were studied. The brief results are follows; 1. Among many ventricular index measured for lateral ventricle, the bifrontal CVI is more sensitive and easily determined. Ventricular size increased with age, especially after 6th decade but no difference with sex. 2. Mean width of third ventricle is 5mm( ± 0.3), more wider in male (male; 5.2mm, female; 4.5mm) and increased with age. 3. Mean width of fourth ventricle is 13mm( ± 1.3), without difference in age and sex. The shape of ventricle is variable form of triangle. The position of ventricle relative to Twining's line can be determined, so ratio of distance from tuberculum sellae to center of fourth ventricle to Twining's line is between 0.46-0.52. 4. Suprasellar cistern is visible in 89.7% of scan and shape of cistern is found to be pentagonal (73.3%), hexagonal (23.0%) and tetragonal (3.7%). 5. Choroid plexus can be identified in 90% and asymetrical in 4%. 45% of identified choroid plexus can be visible on scan without contrast enhancement, and more frequently visible in older age

Evaluation of normal brain CT scan in Korean

International Nuclear Information System (INIS)

Lee, Y. H.; Suh, J. H.; Park, C. Y.

1981-01-01

The safety of procedure combined with wealth of information have resulted in rapid acceptance of CT as a practical and reliable neurodignostic technique. To understand the alternation in tissue density and associated displacement and distortion caused by pathologic lesion in CT, it is necessary to have clear understanding of normal anatomical landmark. For the purpose of establishing normative criteria in Korean for comparative diagnosis, 500 normal CT scan without neurologic sign were studied. The brief results are follows; 1. Among many ventricular index measured for lateral ventricle, the bifrontal CVI is more sensitive and easily determined. Ventricular size increased with age, especially after 6th decade but no difference with sex. 2. Mean width of third ventricle is 5 mm (± 0.3), more wider in male (male; 5.2 mm, female; 4.5 mm) and increased with age. 2. Mean width of fourth ventricle is 13 mm (± 1.3), without difference in age and sex. The shape of ventricle is variable form of triangle. The position of ventricle relative to Twining's line can be determined, so ratio of distance from tuberculum sellae to center of fourth ventricle to Twining's line is between 0.46-0.52. 4. Suprasellar cistern is visible in 89.7% of scan and shape of cistern is found to be pentagonal (73.3%), hexagonal (23.0%) and tetragonal (3.7%). 5. Choroid plexus can be identified in 90% and asymmetrical in 4%. 45% of identified choroid plexus can be visible on scan without contrast enhancement, and more frequently visible in older age

Central nervous system imaging in childhood Langerhans cell histiocytosis – a reference center analysis

International Nuclear Information System (INIS)

Porto, Luciana; Schöning, Stefan; Hattingen, Elke; Sörensen, Jan; Jurcoane, Alina; Lehrnbecher, Thomas

2015-01-01

The aim of our study was (1) to describe central nervous system (CNS) manifestations in children with Langerhans cell histiocytosis (LCH) based on images sent to a reference center and meeting minimum requirements and (2) to assess the inter-rater agreement of CNS-MRI results, which represents the overall reproducibility of this investigation. We retrospectively reviewed brain MRI examinations in children with LCH, for which MRI minimum requirements were met. Abnormalities were rated by two experienced neuroradiologists, and the inter-rater agreement was assessed. Out of a total of 94 imaging studies, only 31 MRIs met the minimum criteria, which included T2w, FLAIR, T1w images before/after contrast in at least two different section planes, and thin post contrast sagittal slices T1w through the sella. The most common changes were osseous abnormalities, followed by solid enlargement of the pineal gland, thickened enhancing stalk and signal changes of the dentate nucleus. Whereas inter-rater agreement in assessing most of the CNS lesions was relatively high (κ > 0.61), the application of minimum criteria often did not allow to evaluate the posterior pituitary. The diversity of radiological protocols from different institutions leads to difficulties in the diagnosis of CNS abnormalities in children with LCH. Although the inter-rater agreement between neuroradiologists was high, not all the LCH manifestations could be completely ruled out when using the minimum criteria. Brain MRIs should therefore follow LCH guideline protocols and include T1 pre-gadolinium sagittal images, and be centrally reviewed in order to improve the comparison of clinical trials

[Clinical feature of chronic compressive optic neuropathy without optic atrophy].

Science.gov (United States)

Jiang, Libin; Shi, Jitong; Liu, Wendong; Kang, Jun; Wang, Ningli

2014-12-01

To investigate the clinical feature of the chronic compressive optic neuropathy without optic atrophy. Retrospective cases series study. The clinical data of 25 patients (37 eyes) with chronic compressive optic neuropathy without optic atrophy, treated in Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, from October, 2005 to March, 2014, were collected. Those patients had been showing visual symptoms for 6 months or longer, but missed diagnosed or misdiagnosed as other eye diseases due to their normal or slightly changed fundi. The collected data including visual acuities, visual fields, neuroimaging and/or pathologic diagnosis were analyzed. Among the 25 patients, there were 5 males and 20 females, and their ages range from 9 to 74 years [average (47.5 ± 13.4) years]. All patients suffered progressive impaired vision in single eye or both eyes, without exophthalmos or abnormal eye movements. Except one patient had a headache, other patients did not show systemic symptoms. The corrected visual acuities were between HM to 1.0, and their appearances of optic discs and colors of fundi were normal. After neuroimaging and/or pathological examination, it was proven that 14 patients suffered tuberculum sellae meningiomas, 5 patients with hypophysoma, 3 patient with optic nerve sheath meningioma in orbital apex, 1 patient with cavernous hemangioma, 1 patient with vascular malformation in orbital apex and 1 patient with optic nerve glioma. Among the 19 patients whose suffered occupied lesions of saddle area, 14 patients underwent visual field examinations, and only 4 patients showed classic visual field defects caused by optic chiasmal lesions. Occult progressive visual loss was the most important clinical feature of the disease.

Management of Severely Atrophic Maxilla in Ectrodactyly Ectodermal Dysplasia-cleft Syndrome

Science.gov (United States)

Rachmiel, Adi; Emodi, Omri; Aizenbud, Dror; Shilo, Dekel

2018-01-01

Background: Ectrodactyly ectodermal dysplasia-cleft syndrome is a rare genetic syndrome with an incidence of 1/90,000 live births, characterized by cleft lip and palate, severely hypoplastic maxilla, and hypodontia. Patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome suffer from a severely hypoplastic maxilla that is highly difficult to treat using traditional orthognathic methods. In this study, we propose using distraction osteogenesis to achieve a major advancement while maintaining good stability and minimal relapse. To our knowledge, this is the first description of patients with this syndrome treated using distraction osteogenesis. Methods: Five patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome were included in the study. All patients had been operated on according to the well-established protocol of cleft lip and palate reconstruction before maxillary distraction osteogenesis. Hard and soft-tissue changes were evaluated by cone beam computed tomography and lateral cephalograms before distraction osteogenesis (T1), at the postdistraction point (T2) and after 1 year of follow-up (T3). Results: Examination revealed marked maxillary advancement in all our patients with a significant mean difference in hard tissue parameters (condylion to A point = 18 mm; nasion-sella line to A point = 15.2 degrees) and a notable improvement in facial convexity (20.9 degrees). One year follow-up measurements demonstrated mild relapse rates of 6% in the horizontal plane. Conclusions: We conclude that despite the challenging anatomic and physiological features of ectrodactyly ectodermal dysplasia-cleft patients, by enhancing current surgical techniques, there is promising potential for improved patient outcomes, achieving normognathic facial appearance with implant supported rehabilitation. PMID:29616174

Hipertrofia mamaria virginal en una adolescente Virginal mammary hypertrophy in an adolescent

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José Raúl Zaldívar Ochoa

2011-09-01

Full Text Available Se presenta el caso clínico de una adolescente de 13 años de edad con antecedentes de buena salud, que acudió a la consulta de endocrinología pediátrica del Hospital Infantil Norte Docente "Dr. Juan de la Cruz Martínez Maceira" de Santiago de Cuba por experimentar un aumento exagerado de ambas mamas, de aparición brusca en una semana y acompañado de enrojecimiento en los senos, elevación de su temperatura, dolor punzante y sensibilidad incrementada, sobre todo en los pezones. Estaba muy afectada psicológicamente; pero se le indicó un tratamiento con antiinflamatorio y diurético antes de ser remitida al Instituto Nacional de Neurología y Neurocirugía para la realización de otra tomografía axial computarizada contrastada, donde no se observaron alteraciones en los hemisferios cerebrales, silla turca, ventrículos y fosa posterior.The case of a 13 year-old adolescent with a history of good health is reported, who attended the Pediatric Endocrinology Department from "Dr Juan de la Cruz Martínez Maceira" Northern Teaching Children Hospital of Santiago de Cuba due to an excessive increase of the breasts, which onset was abrupt in a week and accompanied by breast redness, elevated temperature, piercing pain and increased sensitivity, especially in the nipples. She was so psychologically affected, but she was on anti-inflammatory and diuretic before being referred to the National Institute of Neurology and Neurosurgery to perform another contrast CAT scan, where no changes were observed in the cerebral hemispheres, sella, ventricles and posterior fossa.

Gamma knife radiosurgery for endocrine-inactive pituitary adenomas

International Nuclear Information System (INIS)

Liscak, R.; Vladyka, V.; Simonova, G.; Marek, J.; Vymazal, J.

2007-01-01

The goal of nonsecreting pituitary adenoma radiosurgery is to halt tumor growth and to maintain normal performance of the hypophysis and the functionally important structures around the sella. The effectiveness of gamma knife radiosurgery was evaluated. Over a period of 10 years (1993-2003), 140 patients with nonsecreting pituitary adenoma were treated by Leksell gamma knife at our Centre. Seventy-nine of them were followed up for longer than 3 years. Their age range was 24-73 years, with a median of 54 years. Eighty-five percent of them had previous open surgery. Fifteen patients had adenoma contact with the optic tract. Fourteen patients had a normally functioning hypophysis, 48 patients had complete panhypopituitarism, while the rest retained partial functions of the normal hypophysis. Adenoma volumes ranged between 0.1 and 31.3, the median being 3.45 ccm. The marginal dose ranged between 12 and -35 Gy, with a median of 20 Gy. The follow-up ranged from 36 to 122 months, with a median of 60 months. No adenoma growth was detected; 89 % of treated adenomas decreased in size, with a median volume reduction of 61 %. There was no perimeter vision impairment after radiosurgery, while 4 out of 52 patients with abnormal perimeter vision reported improvement. There was no impairment of oculomotor nerve function. Impairment of hypophysis function was observed in 2 patients. Radiosurgery has a reliable antiproliferative effect on nonsecreting pituitary adenomas. It is a safe treatment with a low risk of morbidity. Short contact between a nonsecreting pituitary adenoma and the optic pathway is not an absolute contraindication for Gamma knife radiosurgery. (author)

Cierre de una fístula oroantral usando cemento óseo y un colgajo de mucosa yugal Closure of an oroantral fistula using bone cement and a jugal mucosa flap

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Beatriz Ágreda Moreno

2012-03-01

Full Text Available Una fístula oroantral es una solución de continuidad patológica entre el seno maxilar y la cavidad oral, producida frecuentemente tras una extracción dentaria, en la mayoría de los casos, del primer o segundo molar. El síntoma más común que provoca es una sinusitis aguda, que evolucionará a la cronicidad si la fístula permanece. El diagnóstico se realiza mediante endoscopia transalveolar, ortopantografía o tomografía computarizada dental. Su cierre quirúrgico es necesario cuando la fístula tiene más de 3 mm, o no sella por sí misma en 3 semanas. Existen, para ello, varias técnicas, usando distintos materiales y colgajos, cuyo fin es ocluir, tanto el defecto óseo, como el mucoso, para solucionar así a la vez la fístula y el problema sinusal.The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. The diagnosis is made by transalveolar, orthopantography or dental computerized tomography. Its surgical closure is necessary when the fistula has more than 3 mm or not seal by itself in three weeks. For it, there are some techniques using different materials and flaps where its objective is to occlude the bone defect as well as the mucous one thus solving the fistula and the sinus problem.

The posterior nasoseptal flap: A novel technique for closure after endoscopic transsphenoidal resection of pituitary adenomas

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Barger, James; Siow, Matthew; Kader, Michael; Phillips, Katherine; Fatterpekar, Girish; Kleinberg, David; Zagzag, David; Sen, Chandranath; Golfinos, John G.; Lebowitz, Richard; Placantonakis, Dimitris G.

2018-01-01

Background: While effective for the repair of large skull base defects, the Hadad-Bassagasteguy nasoseptal flap increases operative time and can result in a several-week period of postoperative crusting during re-mucosalization of the denuded nasal septum. Endoscopic transsphenoidal surgery for pituitary adenoma resection is generally not associated with large dural defects and high-flow cerebrospinal fluid (CSF) leaks requiring extensive reconstruction. Here, we present the posterior nasoseptal flap as a novel technique for closure of skull defects following endoscopic resection of pituitary adenomas. This flap is raised in all surgeries during the transnasal exposure using septal mucoperiosteum that would otherwise be discarded during the posterior septectomy performed in binostril approaches. Methods: We present a retrospective, consecutive case series of 43 patients undergoing endoscopic transsphenoidal resection of a pituitary adenoma followed by posterior nasoseptal flap placement and closure. Main outcome measures were extent of resection and postoperative CSF leak. Results: The mean extent of resection was 97.16 ± 1.03%. Radiographic measurement showed flap length to be adequate. While a defect in the diaphragma sellae and CSF leak were identified in 21 patients during surgery, postoperative CSF leak occurred in only one patient. Conclusions: The posterior nasoseptal flap provides adequate coverage of the surgical defect and is nearly always successful in preventing postoperative CSF leak following endoscopic transsphenoidal resection of pituitary adenomas. The flap is raised from mucoperiosteum lining the posterior nasal septum, which is otherwise resected during posterior septectomy. Because the anterior septal cartilage is not denuded, raising such flaps avoids the postoperative morbidity associated with the larger Hadad-Bassagasteguy nasoseptal flap. PMID:29527390

Diagnosis and temporal evolution of signs of intracranial hypotension on MRI of the brain

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Forghani, R. [McGill University Health Center, Department of Radiology, Montreal, Que (Canada); Massachusetts General Hospital, Division of Neuroradiology, Boston, MA (United States); Farb, R.I. [University of Toronto, Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario (Canada)

2008-12-15

A comprehensive evaluation of cranial magnetic resonance imagings (MRIs) of 23 patients with intracranial hypotension (IH) was performed, and the evolution of the abnormalities on follow-up MRIs was correlated with the clinical outcome. The MRI report database at the University Health Network in Toronto was searched, and 23 cases of IH were identified between 2001 and 2007. A retrospective review of the MRIs of the brain and the electronic patient chart was performed. A control group of 40 subjects was also selected to complement the analysis of the pituitary gland. A positive venous distention sign (VDS) was observed in 23 out of 23 patients and was the first sign to disappear on early follow-up scans following successful treatment. Pachymeningeal enhancement was seen in 23 out of 23 patients, and pachymeningeal thickening was detectable on unenhanced fluid attenuation inversion recovery (FLAIR) sequences in 17 out of 23 patients (74%). An increase in pituitary size in IH was also demonstrated based on the measured pituitary height and was qualitatively detectable in 12 out of 21 (57%) patients as the protrusion of the pituitary gland above the sella turica (two postpartum patients were excluded from this analysis). Overall, there was good correlation between the imaging findings and clinical outcome following treatment. Accurate diagnosis and follow-up of IH should be possible is some patients on unenhanced MRI of the brain by combining the signs on FLAIR and sagittal T1W images, enabling timely diagnosis in unsuspected cases and avoiding unnecessary administration of gadolinium compounds. In addition, VDS might be useful for early assessment of response to treatment. (orig.)

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

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Zhaohui, Liu; Qing, Li [Capital Medical University, Beijing Tongren Hospital, Department of Radiology, Beijing (China); Cheng, Dong; Xiao, Wang; Xiaoyi, Han; Pengfei, Zhao; Han, Lv; Zhenchang, Wang [Capital Medical University, Beijing Friendship Hospital, Department of Radiology, Beijing (China)

2015-07-15

The mechanism of occurrence of sigmoid sinus dehiscence/diverticulum (SSDD) in pulsatile tinnitus (PT) patients remains under debate. Its association with idiopathic intracranial hypertension (IIH) lacks evidence, which is important for therapeutic planning and improving the clinical outcome. This study aimed to evaluate the association between SSDD and IIH by comparing the prevalence of several established imaging features of IIH between PT patients with SSDD and healthy volunteers. Thirty-three unilateral PT patients with SSDD identified on CT images and 33 age- and sex-matched healthy volunteers underwent T1-weighted volumetric magnetic resonance imaging (MRI). The optic nerve, pituitary gland, transverse sinus, and ventricles were assessed. The prevalence of established IIH imaging features was compared between the two groups. Furthermore, the PT patients were divided into two subgroups: PT patients with dehiscence only and PT patients with diverticulum. The same statistical analysis was performed on each pathophysiologic entity respectively. The PT patients with SSDD showed a significantly higher prevalence of empty sella (P < 0.001), flattened posterior sclera (P = 0.001), vertical tortuosity of the optic nerve (P = 0.001), protrusion of the optic nerve (P = 0.006), transverse sinus stenosis (P = 0.011), and distension of the optic nerve sheath (P = 0.000). There were no significant differences between the PT and control groups in the maximum widths of the third and fourth ventricles and the lateral ventricle size. In contrast to controls, the imaging findings persisted in both of pathophysiologic entities, except for transverse sinus stenosis. Several IIH imaging features occur more frequently in PT patients with SSDD than in healthy individuals, which suggests a potential correlation between SSDD with PT and IIH. (orig.)

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

International Nuclear Information System (INIS)

Zhaohui, Liu; Qing, Li; Cheng, Dong; Xiao, Wang; Xiaoyi, Han; Pengfei, Zhao; Han, Lv; Zhenchang, Wang

2015-01-01

The mechanism of occurrence of sigmoid sinus dehiscence/diverticulum (SSDD) in pulsatile tinnitus (PT) patients remains under debate. Its association with idiopathic intracranial hypertension (IIH) lacks evidence, which is important for therapeutic planning and improving the clinical outcome. This study aimed to evaluate the association between SSDD and IIH by comparing the prevalence of several established imaging features of IIH between PT patients with SSDD and healthy volunteers. Thirty-three unilateral PT patients with SSDD identified on CT images and 33 age- and sex-matched healthy volunteers underwent T1-weighted volumetric magnetic resonance imaging (MRI). The optic nerve, pituitary gland, transverse sinus, and ventricles were assessed. The prevalence of established IIH imaging features was compared between the two groups. Furthermore, the PT patients were divided into two subgroups: PT patients with dehiscence only and PT patients with diverticulum. The same statistical analysis was performed on each pathophysiologic entity respectively. The PT patients with SSDD showed a significantly higher prevalence of empty sella (P < 0.001), flattened posterior sclera (P = 0.001), vertical tortuosity of the optic nerve (P = 0.001), protrusion of the optic nerve (P = 0.006), transverse sinus stenosis (P = 0.011), and distension of the optic nerve sheath (P = 0.000). There were no significant differences between the PT and control groups in the maximum widths of the third and fourth ventricles and the lateral ventricle size. In contrast to controls, the imaging findings persisted in both of pathophysiologic entities, except for transverse sinus stenosis. Several IIH imaging features occur more frequently in PT patients with SSDD than in healthy individuals, which suggests a potential correlation between SSDD with PT and IIH. (orig.)

Long-term effect of 90Y pituitary implantation in acromegaly

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Jadresic, A.; Jimenez, L.E.; Joplin, G.F.

1987-01-01

This report examines the long-term trends in GH levels and pituitary function in a group of 38 acromegalic patients who were selected insofar as we were able to follow them up for more than 10 years after a single dose 90 Y interstitial pituitary irradiation as the sole treatment. Mean serum GH had fallen from 106 to 24 mIU/l within 3-6 months and then slowly declined to 4 mIU/l after 10 years. GH levels of ≤5 mIU/l during a 50 g oral glucose tolerance test were obtained in 8% of patients at 3-6 months and in 18% at 1 year, the cumulative percentage increasing to 53% at 10, and 76% at 14 years. The percentage of patients requiring hormone replacement therapy rose from nil pre-implant to 16% by 3-6 months, and then slowly increased to 39% by 14 years. Serial coned radiographs of the pituitary fossa were available for 32 patients. By 10 years, 16 showed thickening of the dorsum sellae and/or reduction of at least one diameter by 3 mm. Concerning symptoms, all 29 patients whose GH level fell to ≤5 mIU/l showed improvements, 22 becoming asymptomatic. Seven patients with lesser falls in GH levels (from a mean of 193 to a mean of 15 mIU/l) all improved, one becoming asymptomatic. Two showed no variation. These results show that 90 Y pituitary implants have a cumulative effect over the years in inducting remission and hypopituitarism in acromegalic patients, the early decline in GH levels being swifter than from other forms of irradiation. (author)

Evolving radiological features of hypothalamo-pituitary lesions in adult patients with Langerhans cell histiocytosis (LCH)

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Makras, P.; Samara, C.; Antoniou, M.; Nikolakopoulou, Z.; Zetos, A.; Papadogias, D.; Piaditis, G.; Kaltsas, G.A.; Toloumis, G.; Andreakos, E.; Kontogeorgos, G.

2006-01-01

Langerhans cell histiocytosis (LCH) is a rare, systemic disease caused by monoclonal expansion of dendritic cells that shows a particular predilection for the hypothalamic-pituitary system (HPS). We studied the function (anterior and posterior pituitary hormonal secretion) and morphology using magnetic resonance imaging (MRI) of the HPS in 17 adult patients (seven males, median age 35 years, range 18-59 years) with multisystem LCH. We also evaluated the evolution of structural HPS abnormalities in relation to pituitary function and response to treatment in 12 of these patients during a median follow-up period of 3.75 years (range 1.5-10 years). Of the 17 patients, 14 (82%) had abnormal HPS imaging, and 12 (70%) had more than one area involved. Lack of the bright spot of the posterior pituitary lobe was typically found in all patients with the diagnosis of diabetes insipidus (DI). Eight patients (47%) had infundibular enlargement, six (35%) pituitary infiltration, four (24%) partially or completely empty sella, three (18%) hypothalamic involvement, and two (12%) infundibular atrophy. DI was found in 16 patients (94%) and anterior pituitary hormonal deficiency (APHD) in 10 patients (59%); two patients had single (12%) and 8 (47%) multiple APHD. During the follow-up period there was improvement of the initially demonstrated HPS pathology in seven (47%) patients, and five (33%) of them had received at least one form of treatment. APHD and DI persisted in all patients except in one in whom established gonadotrophin deficiency recovered. In summary, DI and APHD are very common in patients with multisystem LCH and are almost always associated with abnormal HPS imaging. (orig.)

Endoscopic Endonasal Surgery for Remission of Cushing Disease Caused by Ectopic Intracavernous Macroadenoma: Case Report and Literature Review.

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Koutourousiou, Maria; Winstead, Welby I

2017-02-01

Complete surgical resection of an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the gold standard of treatment of Cushing disease. Ectopic location of these adenomas is an extremely rare condition that may compromise the diagnosis and surgical success. We present the first case of an ectopic intracavernous ACTH-secreting macroadenoma totally resected with endoscopic endonasal surgery (EES). A 36-year-old woman presented with Cushing syndrome. Increased ACTH, serum cortisol, and free urine cortisol levels were identified; however, pituitary magnetic resonance imaging failed to show a pituitary tumor; instead, a parasellar lesion in the left cavernous sinus (CS) was noticed. Inferior petrosal sinus sampling showed a significant central to peripheral and lateralized left-sided ACTH gradient. The patient underwent EES. No tumor was found in the sella; however, the left CS was widely explored and a tumor was found lateral to the paraclival segment of the carotid artery. There were no complications after EES. Pathology confirmed the diagnosis of an ACTH-secreting adenoma. During the immediate postoperative course, serum cortisol levels decreased lower than 5 μg/dL. Postoperative magnetic resonance imaging showed complete tumor resection. At 20 months follow-up, the patient remained in clinical and biochemical remission of Cushing disease. Only 12 cases of ectopic intracavernous ACTH-secreting adenomas have been reported and all were microadenomas. The presence of an ectopic ACTH-secreting macroadenoma in the CS represents a surgical challenge. EES is the ideal approach for complete resection of ectopic intracavernous adenomas, allowing for a wide exploration of the CS with no surgical complications. Copyright © 2016 Elsevier Inc. All rights reserved.

Anatomical and MRI relations of the cerebral aqueduct to the adjacent parts of the brain and calvaria

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Stanković Gordana

2017-01-01

Full Text Available Introducton/Objective. Insufficiency of relevant anatomic data and great neurological and neurosurgical significance were the reasons for this study with scientific and practical implications. The purpose was to determine, at the transverse in situ section of the head, the position and relations of the sylvian aqueduct of the mesencephalon by measuring its distances from particular brain and calvaria structures. Also, the aim was to determine the same distances according to axial sections by using MRI. Methods. The material consisted of twenty autopsy human heads. The section of the head was made at the level of the tentorial hiatus and the midbrain. After that, we measured the distances between the cerebral aqueduct and a posterior border of the optic chiasm, b upper border of the dorsum sellae, c terminal bifurcation of the basilar artery, d beginning of the straight sinus, e internal occipital protuberance, f tentorial edge (lateral from the aqueduct, and g internal surface of the calvaria (lateral to the aqueduct. We determined the same distances by the MRI system. The measurements were made in 37 subjects. Results. The numerical data obtained by this study will be of benefit to neurosurgeons in choosing a surgical approach to the contents of the incisural space, and to neurologists for the exact localization of the lesion and interpretation of certain signs and symptoms. Conclusion. The results of a detailed examination of the sylvian aqueduct position and relations have shown that the use of MRI is the morphometric method of choice, because it is more precise for all the parameters monitored than in situ measurements. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175030

Hyoid bone position and head posture comparison in skeletal Class I and Class II subjects: A retrospective cephalometric study

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Pawankumar Dnyandeo Tekale

2014-01-01

Full Text Available Objective: The aim of the study was to investigate the hyoid bone position and the head posture using lateral cephalograms in subjects with skeletal Class I and skeletal Class II pattern and to investigate the gender differences. Materials and Methods: The study used lateral cephalograms of 40 subjects (20 skeletal Class I pattern; 20 skeletal Class II pattern. Lateral cephalograms were traced and analyzed for evaluation of the hyoid bone position and the head posture using 34 parameters. Independent sample t-test was performed to compare the differences between the two groups and between genders in each group. Statistical tests were performed using NCSS 2007 software (NCSST, Kaysville, Utah, USA. Results: The linear measurements between the hyoid bone (H and cervical spine (CV2ia, the nasion-sella line, palatal line nasion line, the anterior nasal spine (ANS to perpendicular projection of H on the NLP (NLP- Nasal Linear Projection (H-NLP/ANS as well as the posterior cranial points (Bo, Ar and S points were found to be less in skeletal Class II subjects. The measurement H-CV2ia was found to be less in males with skeletal Class I pattern and H-CV4ia was found to be less in males with skeletal Class II pattern. The natural head posture showed no significant gender differences. Conclusion: The position of hyoid bone was closer to the cervical vertebra horizontally in skeletal Class II subjects when compared with skeletal Class I subjects. In males, the hyoid bone position was closer to the cervical vertebra horizontally both in skeletal Class I and skeletal Class II subjects.

Is further evaluation for growth hormone (GH) deficiency necessary in fibromyalgia patients with low serum insulin-like growth factor (IGF)-I levels?

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Yuen, Kevin C J; Bennett, Robert M; Hryciw, Cheryl A; Cook, Marie B; Rhoads, Sharon A; Cook, David M

2007-02-01

Fibromyalgia (FM) is characterized by diffuse pain, fatigue, and sleep disturbances; symptoms that resemble the adult growth hormone (GH) deficiency syndrome. Many FM patients have low serum GH levels, with a hypothesized aetiology of dysregulated GH/insulin-like growth factor (IGF)-I axis. The aim of this study was to assess the GH reserve in FM patients with low serum IGF-I levels using the GH-releasing hormone (GHRH)-arginine test. We retrospectively reviewed the GHRH-arginine data of 77 FM patients with low serum IGF-I levels referred to our tertiary unit over a 4-year period. Of the 77 FM patients, 13 patients (17%) failed the GHRH-arginine test. Further evaluation with pituitary imaging revealed normal pituitary glands (n=7), coincident microadenomas (n=4), empty sella (n=1) and pituitary cyst (n=1), and relevant medical histories such as previous head injury (n=4), Sheehan's syndrome (n=1), and whiplash injury (n=1). In contrast, the remaining 64 patients (83%) that responded to the GHRH-arginine test demonstrated higher peak GH levels compared to age and BMI-matched controls (n=24). Our data shows that a subpopulation of FM patients with low serum IGF-I levels will fail the GHRH-arginine test. We, thus, recommend that the GH reserve of these patients should be evaluated further, as GH replacement may potentially improve the symptomatology of those with true GH deficiency. Additionally, the increased GH response rates to GHRH-arginine stimulation in the majority of FM patients with low serum IGF-I levels further supports the hypothesis of a dysregulated GH/IGF-I axis in the pathophysiology of FM.

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

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Ricardo Landini Lutaif Dolci

Full Text Available Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity and the subarachnoid space (sterile area, reducing the high risk of contamination. Objective: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy, internal nasal valve failure, epistaxis, and olfactory alterations. Results: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension, three had meningiomas (two tuberculum sellae and one olfactory groove, two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%, meningitis (three patients; 7.3%, nasal fossa synechia (eight patients; 19.5%, internal nasal valve failure (six patients; 14.6%, and complaints of worsening of the sense of smell (16 patients; 39%. The olfactory test showed anosmia or hyposmia in ten patients (24.3%. No patient had mucocele, epistaxis, or septal perforation. Conclusion: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted

Histological-subtypes and anatomical location correlated in meningeal brain tumors (meningiomas

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Abdul Rashid Bhat

2014-01-01

Full Text Available Context: Not enough literature is available to suggest a link between the histological subtypes of intracranial meningeal brain tumors, called ′meningiomas′ and their location of origin. Aim: The evidence of correlation between the anatomical location of the intracranial meningiomas and the histopathological grades will facilitate specific diagnosis and accurate treatment. Materials and Methods: The retrospective study was conducted in a single high-patient-inflow Neurosurgical Center, under a standard and uniform medical protocol, over a period of 30 years from December 1982 to December 2012. The records of all the operated 729 meningiomas were analyzed from the patient files in the Medical Records Department. The biodata, x-rays, angiography, computed tomography (CT scans, imaging, histopathological reports, and mortality were evaluated and results drawn. Results: The uncommon histopathological types of meningiomas (16.88% had common locations of origin in the sphenoid ridge, posterior parafalcine, jugular foramen, peritorcular and intraventricular regions, cerebellopontine angle, and tentorial and petroclival areas. The histopathological World Health Organization (WHO Grade I (Benign Type meningiomas were noted in 89.30%, WHO Grade II (Atypical Type in 5.90%, and WHO Grade III (Malignant Type in 4.80% of all meningiomas. Meningiomas of 64.60% were found in females, 47.32% were in the age group of 41-50 years, and 3.43% meningiomas were found in children. An overall mortality of 6.04% was noted. WHO Grade III (malignant meningiomas carried a high mortality (25.71% and the most common sites of meningiomas with high mortality were: The cerebellopontine angles, intraventricular region, sphenoid ridge, tuberculum sellae, and the posterior parafalcine areas. Conclusion: The correlation between the histological subtypes and the anatomical location of intracranial meningeal brain tumors, called meningiomas, is evident, but further research is

Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A 2-Institutional Study

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Yoshikane, Frances; Lai, Li Han; Hui, Brian K.; Martins, Deborah B.; Farias-Eisner, Gina; Mandelbaum, Rachel S.; Hoang, Han; Bradley, James P.; Wilson, Libby

2016-01-01

Background: Understanding long-term sequelae of cleft treatment is paramount in the refinement of treatment algorithms to accomplish optimized immediate and long-term outcomes. In this study, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery. Methods: Cleft lip/palate and cleft palate patients, 15 years of age and older, were reviewed for demographics, VPI surgery, revisions, and subsequent orthognathic surgery at 2 institutions. Chi-square test, Student’s t test, and logistic regression analyses were performed. Results: In 214 patients reviewed (mean age, 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.2% had unilateral cleft lip and palate, and 20.6% had bilateral cleft lip and palate. A total of 33.6% were diagnosed with VPI and received a sphincter pharyngoplasty (mean age, 11.9 years). When subsequent orthognathic surgery was examined, sphincter pharyngoplasty was not associated with maxillary advancement (P = 0.59) but did correlate with an increase in mandibular surgery from 2.8% to 11.1% (P = 0.02). The indications for mandibular surgery in the pharyngoplasty population were related to congenital micrognathia. When cephalometric analyses were evaluated, sphincter pharyngoplasty resulted in a decreased sella-to-nasion-to-B point angle (mean, 79.0–76.3 degrees, P = 0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by A point-to-nasion-to-B point angles >0.5 (P = 0.02). Conclusions: Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships because of the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur. PMID:27200238

Visual findings as primary manifestations in patients with intracranial tumors

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Nazife Sefi-Yurdakul

2015-08-01

Full Text Available AIM:To evaluate the visual findings as primary manifestations in patients with intracranial tumors.METHODS:The medical charts of the patients with intracranial tumors who initially admitted to the Neuro-ophthalmology and Strabismus Department with ocular complaints between August 1999 and December 2012 were reviewed retrospectively. The detailed clinical history and the findings of neuro-ophthalmologic examination were recorded. Ocular symptoms and signs, the types and locations of intracranial tumors, and the duration of symptoms before the diagnosis were evaluated.RESULTS:The mean age of 11 women (61.1% and 7 men (38.9% was 42.2±11.0 (range 20-66y at the time of intracranial tumor diagnosis. Initial symptoms were transient visual obscurations, visual loss or visual field defect in 16 cases (88.9%, and diplopia in 2 cases (11.1%. Neuro-ophthalmologic examination revealed normal optic discs in both eyes of 6 patients (33.3%, paleness, atrophy or edema of optic disc in 12 patients (66.7%, and sixth cranial nerve palsy in 2 patients (11.1%. Visual acuity ranged between normal vision and loss of light perception. Cranial imaging demonstrated craniopharyngioma (n=1, plasmacytoma (n=1, meningioma (n=6; olfactory groove and tuberculum sellae, pontocerebellar angle, anterior cranial fossa, frontal vertex, suprasellar region, and pituitary macroadenoma (n=10. The mean duration between the onset of visual disturbances and the diagnosis of intracranial tumor was 9.8±18mo (range 3d-6y.CONCLUSION:The ophthalmologist is frequently the first physician to encounter a patient with clinical manifestations of intracranial tumors that may cause neurological and ocular complications. Neuro-ophthalmologic findings should be carefully evaluated to avoid a delay in the diagnosis of intracranial tumors.

Infiltración de resina como tratamiento mínimamente invasivo de lesiones de caries dental incipiente

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Alain Manuel Chaple Gil

Full Text Available La mínima intervención en cariología ha sido definida como la filosofía de cuidados estomatológicos que se encarga del tratamiento de la primera aparición, la detección temprana y el tratamiento de la caries dental. Una de las técnicas para el tratamiento temprano y detención de lesiones incipientes es la infiltración de resina. El objetivo es mostrar la utilidad de las resinas fluidas para la infiltración de un primer y segundo molar inferior permanentes con una lesión incipiente de caries dental. Se trata de un paciente masculino de 17 años de edad sin antecedentes patológicos, que acude a consulta estomatológica. En hemiarcada inferior izquierda se observaron manchas en forma de punto de color marrón oscuro cerca de la fosita central y en la estría vestibular del 36 y 37 respectivamente, que no presentaban más de 1 mm de profundidad. Se diagnosticaron lesiones de caries dental incipiente y se decidió realizar una infiltración con resina compuesta de baja viscosidad o fluida en consulta única. El uso de resinas compuestas fluidas es beneficioso en la infiltración de lesiones cariosas incipientes de esmalte, pues evita su propagación y sella las brechas de esmalte afectado. Es una técnica de mínima intervención en cariología, que propicia una solución inmediata para estos procesos y mayor sencillez para la solución de la enfermedad caries dental al equilibrar las expectativas estéticas y de mantenimiento de las estructuras dentarias sanas.

Usefulness of magnetic resonance findings of the hypothalamic-pituitary region in the management of short children with growth hormone deficiency: evidence from a longitudinal study.

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Kalina, Maria A; Kalina-Faska, Barbara; Gruszczyńska, Katarzyna; Baron, Jan; Małecka-Tendera, Ewa

2012-01-01

The purpose of this study is to assess the relationship between magnetic resonance images (MRI) of the hypothalamic-pituitary (H-P) region and response to recombinant human growth hormone (rhGH) treatment in short children with growth hormone deficiency, basing on changes of auxologic parameters, as well as to answer the question if MRI may serve for selecting and monitoring the rhGH responders. The study group comprised 85 children treated with rhGH, aged 7.3-18.7 years, followed for the mean period of 3.2 years (range, 2.1-9.5 years). Auxologic parameters (height deficit hSDS, deviation from the mid-parental height hSDS-mpSDS, bone delay index bone age/chronological age ratio (BA/CA)) were assessed before, during and at the end of rhGH treatment; growth velocity was calculated before and during rhGH therapy. Parameters were correlated with the MRI of the H-P region. Structural anomalies of the H-P region were found in 22 (25.9%) children: empty sella syndrome (ESS) in 12 (14.1%) patients, ectopic posterior pituitary (EPP) in ten (11.8%). Patients' height deficit and their deviation from parental height before rhGH therapy was significantly greater in the EPP group (median hSDS = -3.8; hSDS-mpSDS = -2.5), bone age delay was the greatest in the ESS group (median BA/CA = 0.69), after therapy - in the EPP group (median BA/CA = 0.82). Growth velocity improved in the first year of the rhGH therapy in all groups; however, the most significant acceleration was observed in the EPP group (median delta hSDS = 0.9), then stabilised and was comparable in all groups. MRI may be helpful in predicting response to the rhGH treatment, providing midline abnormalities are taken into account.

Progression from isolated growth hormone deficiency to combined pituitary hormone deficiency.

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Cerbone, Manuela; Dattani, Mehul T

2017-12-01

Growth hormone deficiency (GHD) can present at any time of life from the neonatal period to adulthood, as a result of congenital or acquired insults. It can present as an isolated problem (IGHD) or in combination with other pituitary hormone deficiencies (CPHD). Pituitary deficits can evolve at any time from GHD diagnosis. The number, severity and timing of occurrence of additional endocrinopathies are highly variable. The risk of progression from IGHD to CPHD in children varies depending on the etiology (idiopathic vs organic). The highest risk is displayed by children with abnormalities in the Hypothalamo-Pituitary (H-P) region. Heterogeneous data have been reported on the type and timing of onset of additional pituitary hormone deficits, with TSH deficiency being most frequent and Diabetes Insipidus the least frequent additional deficit in the majority, but not all, of the studies. ACTH deficiency may gradually evolve at any time during follow-up in children or adults with childhood onset IGHD, particularly (but not only) in presence of H-P abnormalities and/or TSH deficiency. Hence there is a need in these patients for lifelong monitoring for ACTH deficiency. GH treatment unmasks central hypothyroidism mainly in patients with organic GHD, but all patients starting GH should have their thyroid function monitored closely. Main risk factors for development of CPHD include organic etiology, H-P abnormalities (in particular pituitary stalk abnormalities, empty sella and ectopic posterior pituitary), midline brain (corpus callosum) and optic nerves abnormalities, genetic defects and longer duration of follow-up. The current available evidence supports longstanding recommendations for the need, in all patients diagnosed with IGHD, of a careful and indefinite follow-up for additional pituitary hormone deficiencies. Copyright © 2017 Elsevier Ltd. All rights reserved.

A review of Craniopharyngioma and the retrospective study on 100 patients

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Larijani B

1995-07-01

Full Text Available This study was performed in order to improve the knowledge about Craniopharyngioma tumors, and tried to present extensive datas about the signs and symptoms, the clinical process and the treatments and their complications of the patients with Craniopharyngioma, admitted in the hospitals of Tehran university during 15 years (1355-70. Ultimately, these datas have been compared with those in the reputable books and new medical papers; And the results are present at the end of the discussion. Undoubtedly, this study is not free of the limitations of retrospective studies. Our patients-contrary to the textbooks are predominantly males; And also their most common chief complaints are neurological manifestations, and headache (82% is the most common one. There is only a little difference in the prevalence of some of the endocrinologic and ophthalmic manifestations between our datas and what in the texts, while, in some others, we can see a great diversity between the 2. For instance, decreased libido in men and amenorrhea in women, among our patients are prominently less than what we study in the books; And blood pressure disturbances, sensory and motor symptoms and urinary incontinence have not been seen in our patients. In most cases, CT scan leads to diagnosis and its diagnostic accuracy in 2 times higher than that of the simple radiography and it can show the sella enlargement obviously. In a majority of cases (More than 95%, excision a part of the tumor (From just limited to the biopsy area to 90% of tumor mass was the only therapeutic measure. In only a few patients, tumor excision was followed by radiotherapy, that showed the better results. The most common delayed complication was the recurrence of the disease.

Long-term effect of /sup 90/Y pituitary implantation in acromegaly

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Jadresic, A.; Jimenez, L.E.; Joplin, G.F.

1987-01-01

This report examines the long-term trends in GH levels and pituitary function in a group of 38 acromegalic patients who were selected insofar as we were able to follow them up for more than 10 years after a single dose /sup 90/Y interstitial pituitary irradiation as the sole treatment. Mean serum GH had fallen from 106 to 24 mIU/l within 3-6 months and then slowly declined to 4 mIU/l after 10 years. GH levels of less than or equal to 5 mIU/l during a 50 g oral glucose tolerance test were obtained in 8% of patients at 3-6 months and in 18% at 1 year, the cumulative percentage increasing to 53% at 10, and 76% at 14 years. The percentage of patients requiring hormone replacement therapy rose from nil pre-implant to 16% by 3-6 months, and then slowly increased to 39% by 14 years. Serial coned radiographs of the pituitary fossa were available for 32 patients. By 10 years, 16 showed thickening of the dorsum sellae and/or reduction of at least one diameter by 3 mm. Concerning symptoms, all 29 patients whose GH level fell to less than or equal to 5 mIU/l showed improvements, 22 becoming asymptomatic. Seven patients with lesser falls in GH levels (from a mean of 193 to a mean of 15 mIU/l) all improved, one becoming asymptomatic. Two showed no variation. These results show that /sup 90/Y pituitary implants have a cumulative effect over the years in inducting remission and hypopituitarism in acromegalic patients, the early decline in GH levels being swifter than from other forms of irradiation.

Visual findings as primary manifestations in patients with intracranial tumors

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Nazife; Sefi-Yurdakul

2015-01-01

· AIM: To evaluate the visual findings as primary manifestations in patients with intracranial tumors.·METHODS: The medical charts of the patients with intracranial tumors who initially admitted to the Neuro-ophthalmology and Strabismus Department with ocular complaints between August 1999 and December 2012 were reviewed retrospectively. The detailed clinical history and the findings of neuro-ophthalmologic examination were recorded. Ocular symptoms and signs,the types and locations of intracranial tumors, and the duration of symptoms before the diagnosis were evaluated.·RESULTS: The mean age of 11 women(61.1%) and 7men(38.9%) was 42.2±11.0(range 20-66y) at the time of intracranial tumor diagnosis. Initial symptoms were transient visual obscurations, visual loss or visual field defect in 16 cases(88.9%), and diplopia in 2 cases(11.1%). Neuro-ophthalmologic examination revealed normal optic discs in both eyes of 6 patients(33.3%),paleness, atrophy or edema of optic disc in 12 patients(66.7%), and sixth cranial nerve palsy in 2 patients(11.1%). Visual acuity ranged between normal vision and loss of light perception. Cranial imaging demonstrated craniopharyngioma(n =1), plasmacytoma(n =1),meningioma(n =6; olfactory groove and tuberculum sellae, pontocerebellar angle, anterior cranial fossa,frontal vertex, suprasellar region), and pituitary macroadenoma(n =10). The mean duration between the onset of visual disturbances and the diagnosis of intracranial tumor was 9.8±18mo(range 3d-6y).·CONCLUSION: The ophthalmologist is frequently the first physician to encounter a patient with clinical manifestations of intracranial tumors that may cause neurological and ocular complications. Neuro-ophthalmologic findings should be carefully evaluated to avoid a delay in the diagnosis of intracranial tumors.

Male hypogonadism at a tertiary care hospital in Karachi, Pakistan.

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Ram, Nanik; Asghar, Ali; Hashmi, Fauzan; Islam, Najmul

2012-01-01

Male hypogonadism is defined as 'inadequate gonadal function, manifested by deficiency in gametogenesis and/or secretion of gonadal hormones'. Signs and symptoms of hypogonadism depend primarily on the age of onset. It can be classified according to the site primarily involved: the gonads, the hypothalamus, or the pituitary gland. The objective this study was to determine the presentation and aetiology of male hypogonadism seen in a tertiary care hospital. This cross-sectional study was conducted at Endocrine Clinics, Aga Khan University Hospital Karachi. Data of male patients with hypogonadism who attended clinics during January 2009 to August 2011 were reviewed. All male patients with clinical and biochemical evidence of hypogonadism were included in the study. Patients with Diabetes Mellitus, Metabolic Syndrome, Andropause, AIDS, Chronic Renal Failure, and Cirrhosis were excluded. Mean +/- SD were computed for quantitative variables. Frequency and percentages were computed for qualitative variables. Aetiology of male hypogonadism was categorised as primary and secondary hypogonadism. A total of 85 patients with male hypogonadism attended the endocrine clinic. Mean age of patients was 25 +/- 10 years. Clinical presentations were small genitalia (65%), absent secondary sexual characteristics (53%), not attained puberty (47%), infertility (53%), erectile dysfunction (41%) and loss of libido (29%). Seventy-three (86%) patients had hypogonadotrophic hypogonadism (secondary hypogonadism) and 12 (14%) patients had hypergonadotrophic hypogonadism (primary hypogonadism). Among the patients with hypogonadotrophic hypogonadism 38 had idiopathic hypogonadotrophic hypogonadsim, 7 had pituitary adenoma, 6 had empty sella syndrome, 3 had Kallman's syndrome, and 1 patient had haemosiderosis due to thalassaemia major; 18 patients did not undergo brain imaging. Small genitalia, absent secondary sexual characteristics and infertility were the main presenting features of hypogonad

24例鞍隔脑膜瘤的分型与手术入路关系%Relationship between typing of diaphragma sellae menin giomas and surgical approaches:A report of 24 cases

Institute of Scientific and Technical Information of China (English)

陈强; 孙克华

2003-01-01

目的探讨不同部位鞍隔脑膜瘤(DSM)分型与手术入路的选择.方法对CT扫描提示为垂体瘤和鞍结节脑膜瘤后再用MRI复查共发现DSM 24例,按Kinjo分型.结果 24例均行手术治疗,19例全部切除,5例大部切除,无手术死亡和严重功能障碍.结论 DSM的分型与临床表现特征、手术入路有密切关系.

Actividad insecticida potencial de sesquiterpenos presentes en Dalea coerulea (L. f. Schinz. et Thellung.

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Arango B Alba Isabel

1994-12-01

Full Text Available

El extracto en éter de petróleo de la parte aérea de Dalea coerulea, especie vegetal nativa de Colombia usada en el control de insectos, se sometió a separaciones cromatografías guiadas por bioensayo general de toxicidad con Artemia salina. Las fracciones activas se purificaron por cromatografía repetitiva y los productos se controlaron con bioensayos de toxicidad general y específicos. Una fracción denominada F2, constituida por mono y sesquiterpenos, mostró acción repelente e insecticida sobre Xenopsylla sp. Y Macrosiphum rosae. De la otra fracción llamada F7, se separaron 4 flavanonas y una mezcla compleja de carácter terpenoide. Las flavanonas puras no dieron actividad tóxica significativa, pero la mezcla presentó alta acción tóxica con larvas de Spodoptera sunia y acción larvicida con Gallería mellonella y Achroia grísella.

Class III camouflage treatment: what are the limits?

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Burns, Nikia R; Musich, David R; Martin, Chris; Razmus, Thomas; Gunel, Erdogan; Ngan, Peter

2010-01-01

The purpose of this study was to determine the skeletal, dental, and soft-tissue changes in response to camouflage Class III treatment. Thirty patients (average age, 12.4 + or - 1.0 years) with skeletal Class III malocclusions who completed comprehensive nonextraction orthodontic treatment were studied. Skeletal, dental, and soft-tissue changes were determined by using published cephalometric analyses. The quality of orthodontic treatment was standardized by registering the peer assessment rating index on the pretreatment and posttreatment study models. The change in the level of gingival attachment with treatment was determined on the study casts. The results were compared with a group of untreated subjects. Data were analyzed with repeated measures analysis and paired t tests. The average change in the Wits appraisal was greater in the treated group (1.2 + or - 0.1 mm) than in the control group (-0.5 + or - 0.3 mm). The average peer assessment rating index score improved from 33.5 to 4.1. No significant differences were found for the level of gingival attachments between the treatment and control groups. The sagittal jaw relationship (ANB angle) did not improve with camouflage treatment. A wide range of tooth movements compensated for the skeletal changes in both groups. The upper and lower limits for incisal movement to compensate for Class III skeletal changes were 120 degrees to the sella-nasion line and 80 degrees to the mandibular plane, respectively. Greater increases in the angle of convexity were found in the treated group, indicating improved facial profiles. Greater increases in length of the upper lip were found in the treated group, corresponding to the changes in the hard tissues with treatment. Significant dental and soft-tissue changes can be expected in young Class III patients treated with camouflage orthodontic tooth movement. A wide range of skeletal dysplasias can be camouflaged with tooth movement without deleterious effects to the

Domain Modeling and Application Development of an Archetype- and XML-based EHRS. Practical Experiences and Lessons Learnt.

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Kropf, Stefan; Chalopin, Claire; Lindner, Dirk; Denecke, Kerstin

2017-06-28

Access to patient data within the hospital or between hospitals is still problematic since a variety of information systems is in use applying different vendor specific terminologies and underlying knowledge models. Beyond, the development of electronic health record systems (EHRSs) is time and resource consuming. Thus, there is a substantial need for a development strategy of standardized EHRSs. We are applying a reuse-oriented process model and demonstrate its feasibility and realization on a practical medical use case, which is an EHRS holding all relevant data arising in the context of treatment of tumors of the sella region. In this paper, we describe the development process and our practical experiences. Requirements towards the development of the EHRS were collected by interviews with a neurosurgeon and patient data analysis. For modelling of patient data, we selected openEHR as standard and exploited the software tools provided by the openEHR foundation. The patient information model forms the core of the development process, which comprises the EHR generation and the implementation of an EHRS architecture. Moreover, a reuse-oriented process model from the business domain was adapted to the development of the EHRS. The reuse-oriented process model is a model for a suitable abstraction of both, modeling and development of an EHR centralized EHRS. The information modeling process resulted in 18 archetypes that were aggregated in a template and built the boilerplate of the model driven development. The EHRs and the EHRS were developed by openEHR and W3C standards, tightly supported by well-established XML techniques. The GUI of the final EHRS integrates and visualizes information from various examinations, medical reports, findings and laboratory test results. We conclude that the development of a standardized overarching EHR and an EHRS is feasible using openEHR and W3C standards, enabling a high degree of semantic interoperability. The standardized

Management of cerebrospinal fluid leak during endoscopic pituitary surgery.

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Berker, Mustafa; Aghayev, Kamran; Yücel, Taşkın; Hazer, Derya Burcu; Onerci, Metin

2013-08-01

Dural opening and closures are major steps in endoscopic pituitary surgery. Restoring the normal anatomy at the end of the procedure creates a natural barrier between the intrasellar compartment and the sinonasal cavity. In this study, we present a relatively simple dural opening and closure technique for endoscopic pituitary surgery. This technique provides a better alternative to the use of a more complex nasoseptal flap or the multilevel closure with artificial materials as it restores the normal anatomy after the tumor removal and provides a better physiological barrier between the sinonasal cavity and the intrasellar compartment. Incision is performed in circular or horseshoe fashion leaving a small peduncle, and then the dura is reflected. Of the 733 endoscopic transsphenoidal procedures in 667 patients conducted between January 2006 and May 2012, we used this described technique in 50 cases (7.4%). In these 50 cases with dural flap, there was no postoperative CSF leakage. Intraoperative CSF leakage was observed in 135 (20.2%) of the 667 patients. In 15 (11.1%) of these 135 patients we used the dural flap technique accompanied with fat and/or fascia lata support. There was no postoperative leakage in these patients. In the remaining 120 (89.9%) patients who had intraoperative CSF leakage, we used fat and/or fascia lata for the reconstruction of the sella floor. But we observed postoperative CSF leakage in 12 (10%) of the 120 patients without the dural flap which were reoperated. The dural flap technique we employ has several advantages. First of all, it allows optimal physiological reconstruction after the surgery. Secondly, the bridge between the flap and the main dura helps maintain the vascular supply, which in turn can radically shorten the healing time. Thirdly, this technique is obviously a better alternative to the time consuming and expensive multilevel closures with tissue sealants and artificial grafts. Copyright © 2012 Elsevier Ireland Ltd. All

Computerized tomographic visualization of niveau by turning the head in a case of pituitary apoplexy

International Nuclear Information System (INIS)

Sasajima, Toshio; Mineura, Katsuyoshi; Kowada, Masayoshi; Sasaki, Junko; Sasajima, Hiroyasu; Sakamoto, Tetsuya

1987-01-01

A case of pituitary apoplexy is presented in which a free niveau formation, a pathognomonic sign of this entity, was proved by means of computerized tomography (CT) by turning the head. A 48-year-old female had developed a sudden, excruciating, retroorbital headache, vomiting, and visual disturbance twice prior to admission. The visual acuity was 0.1 in the right eye and 0.6 in the left eye. The optic fundi were normal. There was a right temporal field loss and a left upper temporal quadrantanopsia. A plain skull film disclosed ballooning and a double floor of the turcic sella. A CT scan of the head, performed by means of a GE CT/T 8800 Scanner, showed an intrasellar low-density mass with a slightly enhanced rim. We were not convinced of the presence of a high-density area, though there seemed to be one adjacent to the posterior clinoid process and the turcic floor, because of the partial volume effect and the artifact related to the neighboring bones. Another high-resolution CT scan on the ensuing day, as the head was turned and then kept still at about 45 degrees to the right, while the patient was supine, for ten minutes, made it possible to visualize a free fluid level, comparable to a fluid-blood-density level. A transsphenoidal pituitary exploration identified blood fluid collection in the encapsulated tumor, a finding which was histologically consistent with the sinusoidal type of chromophobe adenoma. There was some microscopic evidence of necrosis and hemosiderin laden cells. The postoperative course was uneventful; visual acuity improved without delay, and the temporal field defect became significantly smaller. Two weeks later, visual acuity had recovered to 1.2 uncorrected in each eye. CT and the pertinent position of the head might be quite helpful for the visualization and confirmation of a subtle free fluid level in cases of pituitary apoplexy. (author)

A Comparison of Dexmedetomidine and Clonidine in Attenuating the Hemodynamic Responses at Various Surgical Stages in Patients Undergoing Elective Transnasal Transsphenoidal Resection of Pituitary Tumors.

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Jan, Summaira; Ali, Zulfiqar; Nisar, Yasir; Naqash, Imtiaz Ahmad; Zahoor, Syed Amer; Langoo, Shabir Ahmad; Azhar, Khan

2017-01-01

Transsphenoidal approach to pituitary tumors is a commonly performed procedure with the advantage of a rapid midline access to the sella with minimal complications. It may be associated with wide fluctuations in hemodynamic parameters due to intense noxious stimulus at various stages of the surgery. As duration of the surgery is short and the patients have nasal packs, it is prudent to use an anesthestic technique with an early predictable recovery. A total of 60 patients of either sex between 18 and 65 years of age, belonging to the American Society of Anesthesiologists I and II who were undergoing elective transnasal transsphenoidal pituitary surgery were chosen for this study. Patients were randomly allocated into two groups, Group C (clonidine) and Group D (dexmedetomidine), with each group consisting of 30 patients. Patients in Group C received 200 μg tablet of clonidine and those in Group D received a pantoprazole tablet as placebo at the same time. Patients in the Group D received an intravenous infusion of dexmedetomidine diluted in 50 ml saline (200 μg in 50 ml saline) 10 min before induction and patients in Group C received 0.9% normal saline (50 ml) as placebo. The hemodynamic variables (heart rate, mean arterial pressure) were noted at various stages of the surgery. Statistical analysis of the data was performed. A total of 60 patients were recruited. The mean age, sex, weight and duration of surgery among the two groups were comparable ( P > 0.05). Both dexmedetomidine and clonidine failed to blunt the increase in hemodynamic responses (heart rate and blood pressure) during intubation, nasal packing, speculum insertion and extubation. However when the hemodynamic response was compared between the patients receiving dexmedetomidine and clonidine it was seen that patients who received dexmedetomidine had a lesser increase in heart rate and blood pressure ( P < 0.05) when compared to clonidine. A continuous intravenous infusion of dexmedetomidine as

The prevalence of IgG4-related hypophysitis in 170 consecutive patients with hypopituitarism and/or central diabetes insipidus and review of the literature.

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Bando, Hironori; Iguchi, Genzo; Fukuoka, Hidenori; Taniguchi, Masaaki; Yamamoto, Masaaki; Matsumoto, Ryusaku; Suda, Kentaro; Nishizawa, Hitoshi; Takahashi, Michiko; Kohmura, Eiji; Takahashi, Yutaka

2014-02-01

The prevalence and clinical characteristics of IgG4-related hypophysitis remain unclear due to the limited number of case reports. Therefore, in this study, we screened consecutive outpatients with hypopituitarism and/or diabetes insipidus (DI) to estimate its prevalence. A total of 170 consecutive outpatients with hypopituitarism and/or central DI were screened at Kobe University Hospital for detecting IgG4-related hypophysitis by pituitary magnetic resonance imaging, measuring serum IgG4 concentrations, assessing the involvement of other organs, and carrying out an immunohistochemical analysis to detect IgG4-positive cell infiltration. Among the screened cases, 116 cases were excluded due to diagnosis of other causes such as tumors and congenital abnormalities. Additionally, 22 cases with isolated ACTH deficiency were analyzed and were found not to meet the criteria of IgG4-related hypophysitis. The remaining 32 cases were screened and seven were diagnosed with IgG4-related hypophysitis, of which three cases were diagnosed by analyzing pituitary specimens. IgG4-related hypophysitis was detected in 30% (seven of 23 patients) of hypophysitis cases and 4% of all hypopituitarism/DI cases. The mean age at the onset of IgG4-related hypophysitis was 61.8±8.8 years, and the serum IgG4 concentration was 191.1±78.3 mg/dl (normal values 5-105 mg/dl and values in IgG4-related disease (RD) ≥135 mg/dl). Pituitary gland and/or stalk swelling was observed in six patients, and an empty sella was observed in one patient. Multiple co-existing organ involvement was observed in four of the seven patients prior to the onset of IgG4-related hypophysitis. These data suggest that the prevalence of IgG4-related hypophysitis has been underestimated. We should also consider the possibility of the development of hypopituitarism/DI caused by IgG4-related hypophysitis during the clinical course of other IgG4-RDs.

Endoscopic transnasal resection of anterior cranial fossa meningiomas.

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de Divitiis, Enrico; Esposito, Felice; Cappabianca, Paolo; Cavallo, Luigi M; de Divitiis, Oreste; Esposito, Isabella

2008-01-01

The extended transnasal approach, a recent surgical advancements for the ventral skull base, allows excellent midline access to and visibility of the anterior cranial fossa, which was previously thought to be approachable only via a transcranial route. The extended transnasal approach allows early decompression of the optic canals, obviates the need for brain retraction, and reduces neurovascular manipulation. Between 2004 and 2007, 11 consecutive patients underwent transnasal resection of anterior cranial fossa meningiomas--4 olfactory groove (OGM) and 7 tuberculum sellae (TSM) meningiomas. Age at surgery, sex, symptoms, and imaging studies were reviewed. Tumor size and tumor extension were estimated, and the anteroposterior, vertical, and horizontal diameters were measred on MR images. Medical records, surgical complications, and outcomes of the patients were collected. A gross-total removal of the lesion was achieved in 10 patients (91%), and in 1 patient with a TSM only a near-total (> 90%) resection was possible. Four patients with preoperative visual function defect had a complete recovery, whereas 3 patients experienced a transient worsening of vision, fully recovered within few days. In 3 patients (2 with TSMs and 1 with an OGM), a postoperative CSF leak occurred, requiring a endoscopic surgery for skull base defect repair. Another patient (a case involving a TSM) developed transient diabetes insipidus. The operative time ranged from 6 to 10 hours in the OGM group and from 4.5 to 9 hours in the TSM group. The mean duration of the hospital stay was 13.5 and 10 days in the OGM and TSM groups, respectively. Six patients (3 with OGMs and 3 with TSMs) required a blood transfusion. Surgery-related death occurred in 1 patient with TSM, in whom the tumor was successfully removed. The technique offers a minimally invasive route to the midline anterior skull base, allowing the surgeon to avoid using brain retraction and reducing manipulation of the large vessels and

Temporal distribution and behaviour of sand flies (Diptera: Psychodidae) in a cutaneous leishmaniasis focus of the Kani Tribe settlements in the Western Ghats, India.

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Srinivasan, R; Jambulingam, P; Kumar, N Pradeep; Selvakumar, M; Edwin, B; Kumar, T Dilip

2015-08-01

The temporal distribution of sand flies in relation to environmental factors was studied in the Kani tribe settlements located on the southernmost part of the Western Ghats, Kerala, India, between June 2012 and May 2013. This area is known for occurrence of cutaneous leishmaniasis (CL) cases. Employing hand-held aspirator, light trap and sticky-trap collection methods, a total of 7874 sand fly specimens, comprising 19 species was collected. Sergentomyia baghdadis was predominant species, followed by Phlebotomus argentipes. Sand fly abundance was significantly higher indoors (χ(2)=9241.8; p=0.0001) than outdoors. Mean density of P. argentipes in human dwellings, cattle sheds and outdoors was 7.2±2.9, 27.33±21.1 and 0.64±0.2 females/per man-hour (MHR), respectively. No sand fly species other than P. argentipes was obtained from cattle sheds. Although, sand fly populations were prevalent throughout the year, their abundance fluctuated with seasonal changes. Multiple regression analysis with backward elimination indicated that the increase in precipitation and relative humidity contributed to a significant positive association with the increase in sand fly abundance, while the increase in temperature showed no association. Fully engorged female sand flies tested for blood meal source showed multiple host-blood feeding. Analysis of resting populations of sand flies collected from human shelters indicated that the populations were found maximum on interior walls at 6-8 and >8 ft height, including ceiling during summer (F=83.7, df=6, p=0.001) and at the lower half of the wall at 0 and 0-2 ft height, during monsoon season (F=41.4, df=6, p=0.001). In cooler months, no preference to any height level (F=1.67, df=6, p=0.2) was observed. Proportion of females sand flies with Sella's classification of abdominal stages, namely full-fed, half-gravid and gravid females did not vary significantly (t=1.98, p=0.13827) indoors, confirming their endophilic behaviour. Risk of CL

Endoscopic Endonasal Approach in the Management of Rathke's Cleft Cysts.

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Domenico Solari

to the supradiaphragmatic space, allowing adequate view and room for the safe removal of selected supradiaphragmatic RCCs, regardless of the sellar size (even a not enlarged sella, and provides a higher likelihood of preserving normal pituitary tissue and functions.

Forty month follow-up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide

International Nuclear Information System (INIS)

Yetkin, D.O.; Boysan, S.N.; Tiryakioglu, O.; Yalin, A.S.; Kadioglu, P.

2007-01-01

The objective of the present study was to investigate the effects of octreotide long acting release (S-LAR) preparation on growth hormone (GH) and insulin-like growth factor (IGF)-1 serum concentrations and pituitary tumor size in patients with persistent and difficultly controlled acromegaly even after adjuvant irradiation and/or dopamine agonists. Thirty-three patients with active acromegaly (26 female and 7 male, mean age; 43.94±14.01 standard deviation (SD) years) were included in this study. Patients were evaluated at baseline and at 6, 12, 30 and 40 months for GH, IGF-1, and GH response to oral glucose tolerance test (OGTT) and biliary ultrasonography. Sella MRI was performed at initial and at 40 months. All patients received 20 mg S-LAR. Afterwards, the dosage was titrated to improve individual GH response and reduction of IGF-1 into normal ranges. Basal serum IGF-1 levels decreased from median: 530 μg/l [IQR: 420-600] to 340 μg/l [IQR: 230-460] at 6 months (p=0.01), to 400 μg/l [IQR: 222.4-600] at 12 months (p=0.48), to 396 μg/l [IQR: 318-468] at 30 months (p=0.49), to 482 μg/l [308-580] at 40 months (p=0.47). Nadir GH levels in OGTT fell from 2.70 ng/ml [IQR: 1.35-6.90] to 1.60 ng/ml [IQR: 0.36-4.10] at 6 months (p=0.03), to 0.31 ng/ml [IQR: 0.18-0.65] at 12 months (p<0.0001), to 1.50 ng/ml [IQR: 0.83-4.00] at 30 months (p=0.398) and to 0.89 ng/ml [IQR: 0.58-1.35] at 40 months (p<0.0001). Initially, pituitary adenoma volume was median: 1.18 ml [IQR: 0.08-3.50] and it shrank to 0.21 ml [IQR: 0-2.1] at 40 months (p=0.08). Gallstones were detected in 12 patients and six of them underwent cholecystectomy. S-LAR is an effective treatment regimen in reducing GH and IGF-1 concentrations and as well as in shrinking tumor volume in persistent and difficultly controlled acromegalic patients. (author)

[Extradural temporopolar approach for surgical management of paraclinoid lesions].

Science.gov (United States)

Otani, Naoki; Wada, Kojiro; Kobayashi, Yasushi; Kumagai, Kohsuke; Ueno, Hideaki; Osada, Hideo; Nakao, Yasuaki; Yamamoto, Takuji; Mori, Kentaro

2014-10-01

Surgical treatment of paraclinoid tumors adjacent to important anatomical structures, such as the optic nerve, optic chiasm, pituitary stalk, and internal carotid artery, should emphasize maximum resection and preservation of visual function. Thus, early localization and exposure of the optic nerve, and complete mobilization and decompression of the optic nerve and internal carotid artery, are necessary in order to prevent intraoperative neurovascular injuries. However, this technique requires wide exposure of the optic-carotid space through the interpeduncular cistern. We have developed an extradural temporopolar approach for resection of paraclinoid tumors, which can also allow early devascularization of arteries that feed the tumors. We evaluated the surgical outcomes of this approach, paying special attention to clinical and visual outcomes. Thirteen patients(4 men, 9 women;24-78 years, mean age 54 years), underwent tumor removal using an extradural temporopolar approach between March 2000 and April 2013. We retrospectively reviewed medical charts, radiological findings, intensive care unit flow sheets, and surgical records. Histological diagnoses included craniopharyngioma(4 cases), pituitary adenoma(3 cases), medial sphenoid ridge meningioma(2 cases), tuberculum sellae meningioma(2 cases), trigeminal neurinoma(1 case), and malignant epidermoid(1 case). Tumors were 1.5-6.0cm in length(mean 3.2cm). Tumors were cystic in all 4 craniopharyngiomas and solid in the other 9 cases. Preoperative neurological deficits included visual disturbance in 10 patients, double vision caused by oculomotor nerve palsy in 2 patients, and vertigo in 1 patient. Additional orbitozygomatic craniotomies were performed in 8 patients. Total tumor removal was performed in 7 patients and subtotal removal performed in 6. The pituitary stalk was microscopically preserved in all patients. Postoperative complications included transient diabetes insipidus in 2 patients, chronic subdural

The pituitary gland in patients with Langerhans cell histiocytosis: a clinical and radiological evaluation.

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Kurtulmus, Neslihan; Mert, Meral; Tanakol, Refik; Yarman, Sema

2015-04-01

Langerhans cell histiocytosis (LCH) is a rare disease in which the most common endocrine manifestation is diabetes insipidus (DI). Data on anterior pituitary function in patients with LCH are limited. Thus, the present study investigated anterior pituitary function in LCH patients with DI via the evaluation of clinical and radiological findings at disease onset and during follow-up. The present study retrospectively evaluated nine patients with LCH (five males and four females). All diagnoses of LCH were made following histological and/or immunophenotypic analyses of tissue biopsies, bronchoalveolar lavage, or cerebrospinal fluid (CSF). Basal and, if necessary, dynamic pituitary function tests were used to assess anterior pituitary function, and magnetic resonance imaging (MRI) scans were used to image the pituitary. The LCH treatment modality was based on organ involvement. The mean age at onset of DI was 27.6 years (range 15-60 years). One patient (11%) exhibited single organ involvement, while eight patients (89%) displayed multisystem organ involvement. On admittance, one patient had hypogonadotropic hypogonadism, one patient exhibited panhypopituitarism [hypogonadotropic hypogonadism, central hypothyroidism, hypocortisolism, and growth hormone (GH) deficiency], and four patients (44%) displayed hyperprolactinemia. The MRI data revealed infundibular enlargement in seven patients (78%), a thalamic mass in one patient (11%), and the absence of the bright spot in all patients. A single patient (11%) showed a mass in the pons that had a partially empty sella. The patients were treated with radiation therapy (RT), chemotherapy (CT), or a combination of both (RT+CT) and were followed up for a median of 91.8 months (range 2-318 months). Seven patients were assessed during the follow-up period, of whom four patients (57.1%) developed anterior pituitary hormone deficiency, three (43%) were diagnosed with GH deficiency, and one (14%) exhibited gonadotropin deficiency

Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors using Image-based Vascular and Cranial Nerve Segmentation: A Prospective Validation Study

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Dolati, Parviz; Eichberg, Daniel; Golby, Alexandra; Zamani, Amir; Laws, Edward

2016-01-01

Introduction Transsphenoidal surgery (TSS) is a well-known approach for the treatment of pituitary tumors. However, lateral misdirection and vascular damage, intraoperative CSF leakage, and optic nerve and vascular injuries are all well-known complications, and the risk of adverse events is more likely in less experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation in localization of neurovascular structures during TSS. Methods Twenty-five patients with pituitary tumors underwent preoperative 3TMRI, which included thin-sectioned 3D space T2, 3D Time of Flight and MPRAGE sequences. Images were reviewed by an expert independent neuroradiologist. Imaging sequences were loaded in BrainLab iPlanNet (16/25 cases) or Stryker (9/25 cases) image guidance platforms for segmentation and pre-operative planning. After patient registration into the neuronavigation system and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe on or as close as possible to the target. The audible pulsations of the bilateral ICA were confirmed using a micro-Doppler probe. Results Pre-operative segmentation of the ICA and cavernous sinus matched with the intra-operative endoscopic and micro-Doppler findings in all cases (Dice Similarity Coefficient =1). This information reassured the surgeons with regard to the lateral extent of bone removal at the sellar floor and the limits of lateral exploration. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor-normal gland interfaces. This assisted in preventing unnecessary removal of the normal pituitary gland. Image-guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of the cases and the diaphragma sella in 52% of cases, which helped to determine the limits of upward exploration and to decrease the risk of CSF

Image guidance in trans-sphenoidal surgery for giant pituitary adenomas: Luxury or necessity?

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Deepak Agrawal

2012-01-01

Full Text Available Background: In spite of availability of image guidance (neuronavigation at major centers around the world, most trans-sphenoidal surgeries for pituitary adenomas continue to be done under fluoroscopic control. On the other hand, the high mortality and morbidity for giant pituitary adenomas is mainly due to inadequate tumor removal. Aims and Objectives: The objective of this study was to study to utility of image guidance in trans-sphenoidal surgeries for optimizing tumor removal in giant pituitary adenomas. Materials and Methods: This was a prospective study carried out over a two years (January 2009-December 2010 in the Department of Neurosurgery, All India Institute of Medical Sciences. Patients with giant pituitary adenomas who underwent trans-sphenoidal surgery by the author were included. All surgeries were done under image-guidance only and no fluoroscopy was employed. Trajectory was defined using the image guidance and bone work done accordingly to optimize tumor removal. All patients had a contrast CT of the head done within 48 h of surgery to see for residual tumor. Observations and Results: Sixteen patients with pituitary adenomas were operated using only image-guidance in the study period. Twelve patients had virgin tumors and four patients had recurrent/residual tumors. In four patients, noncontrast MR images were used in for image guidance and contrast CT images were used in the rest. The mean set up time for image-guidance was 11 min (range 7-15 min. The mean ′′overall accuracy of registration′′ was 1.6 mm (range 1.4-2.1 mm. The mean operating time was 72 min (range 52-96 min. In all cases, midline and the relation of the carotid artery to the sella could be confirmed using the image-guidance. There were no intraoperative complications. Postoperative scans showed residual tumor in nine patients. The residual tumor was 25% in one patient (with a fibrous recurrent/residual tumor. Conclusions: Image guidance markedly improves

LEDs light spectrum effect on the success of fragmentation and growth of the leather coral Sarcophyton spp.

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João Chambel

2014-06-01

Full Text Available The increasing demand for soft corals is reflected on the high attention of the scientific community during the last decades, with several studies focus on production techniques and optimization of coral husbandry (Schlacher et al., 2007;Sella and Benayahu, 2010. However, coral culture success is influenced by the interaction of different factors, such as water movement, temperature, nutrients, heterotrophic feeding and light conditions (Rocha et al., 2013a. Light plays a key role in the growth, reproduction and physiology of scleractinian corals that host phototrophic symbionts and it has been found that the photoresponse of corals is species-specific. Several studies have already focused on the effects of irradiance on coral and its algal symbionts (Osinga et al., 2011. Although, only a few works have investigated the role of the spectral quality of light on coral photobiology, physiology and growth (Rocha et al., 2013b. In the present study, we hypothesize that light spectrum can influence the growth performance of scleractinian corals when exposed at identical intensities of photosynthetically active radiation (PAR. To test our hypothesis we evaluated the effect of contrasting light spectra with an identical PAR of 70 ± 10 μmol quantam−2.s−1emitted by T8 fluorescent lamps (used as a control treatment and three different colours of Light Emitting Diode (LED, white, blue and red. It was evaluated survival and growth rates of Sarcophyton spp., an important scleractinian coral in the marine aquarium trade and for the bioprospecting of marine natural compounds. Replicated coral fragments were obtained from two mother colonies and were exposed to the four types of light spectrum for a period of 30 days. At the end of the experiment period, the results showed 100% of survival in coral fragments, and specific growth rate (SGR of 0,055 ± 0,09 %/day in control group and 0,091 ± 0,019 %/day, 0,210 ± 0,031 %/day and 0,380 ± 0,245 %/day in

Influence of orthodontic appliance-derived artifacts on 3-T MRI movies.

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Ozawa, Erika; Honda, Ei-Ichi; Parakonthun, Kulthida Nunthayanon; Ohmori, Hiroko; Shimazaki, Kazuo; Kurabayashi, Tohru; Ono, Takashi

2018-02-19

Magnetic resonance imaging (MRI) has been used to study configurations of speech organs in the resting state. However, MRI is sensitive to metals, and numerous types of metallic appliances, most of which have a large magnetic susceptibility, are used in orthodontic treatment and may cause severe artifacts on MRI. We have developed techniques for obtaining MRI movies of the oral region, to evaluate articulatory changes, especially movement of the tongue, palate, and teeth, pre- and post-orthodontic/orthognathic treatment. We evaluated the influence of artifacts caused by orthodontic appliances, including fixed retainers, metal brackets, and wires, on measurements in 3-T MRI movies. Sixteen healthy young adults (nine males, seven females; average age, 27 years) with normal occlusion were recruited. Four types of customized maxillary and mandibular plates were prepared by incorporating one of the following into the plate: (a) nothing, (b) a fixed canine-to-canine retainer, (c) metal brackets for the anterior and molar teeth, or (d) clear brackets for the anterior teeth and metal brackets for molars. A 3-T MRI movie, in segmented cine mode, was generated for each plate condition while participants pronounced a vowel-consonant-vowel syllable (/asa/). The size of the artifact due to the metallic brackets was measured. The face size and orthodontically important anatomical structures, such as the velum, the hard palate, and the laryngeal ventricle, were also measured. A large artifact was observed over the entire oral region around orthodontic appliances, altering regional visibility. The velopharyngeal height was measured as significantly longer in the presence of metal brackets. The maximum artifact size due to a metallic bracket was > 8 cm. Our results show that even if it is possible to obtain the measurements of palate length, nasion to sella, and nasion to basion in individuals wearing metal brackets for molars, the measurements might be affected due to the

Computed tomography scan of the head in patients with migraine or tension-type headache Tomografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional

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Marcelo Moraes Valença

2002-09-01

Full Text Available A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%, cysticercosis (3.9%, unruptuted cerebral aneurysm (2.6%, basilar impression (2.6%, intracranial lipoma (2.6%, arachnoid cyst (2.6%, empty sella (2.6%, intracranial neoplasm (2.6%, and others (2.6%. None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.Um estudo retrospectivo foi realizado visando avaliar a frequência de anormalidades encontradas durante a realização de estudo por tomografia computadorizada (TC em 78 pacientes com migrânea ou cefaléia do tipo tensional. A TC foi normal em 61,5% dos pacientes examinados. Em um terço dos pacientes estudados foram detectadas anormalidades, como doença inflamatória dos seios paranasais (19,2%, cisticercose (3,9%, aneurisma cerebral não-roto (2,6%, impressão basilar (2,6%, lipoma intracraniano (2,6%, cisto aracnoideo (2,6%, sela vazia (2,6%, neoplasia intracraniana (2,6% e outras afecções (2,6%. Nenhuma destas lesões era sintomática (achado incidental. Concluindo, o encontro fortuito de algumas anormalidades na TC é frequentemente mais elevado do que se prediz em pacientes com cefaléia primária. Nós discutimos brevemente alguns

Surgical outcomes after reoperation for recurrent skull base meningiomas.

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Magill, Stephen T; Lee, David S; Yen, Adam J; Lucas, Calixto-Hope G; Raleigh, David R; Aghi, Manish K; Theodosopoulos, Philip V; McDermott, Michael W

2018-05-04

OBJECTIVE Skull base meningiomas are surgically challenging tumors due to the intricate skull base anatomy and the proximity of cranial nerves and critical cerebral vasculature. Many studies have reported outcomes after primary resection of skull base meningiomas; however, little is known about outcomes after reoperation for recurrent skull base meningiomas. Since reoperation is one treatment option for patients with recurrent meningioma, the authors sought to define the risk profile for reoperation of skull base meningiomas. METHODS A retrospective review of 2120 patients who underwent resection of meningiomas between 1985 and 2016 was conducted. Clinical information was extracted from the medical records, radiology data, and pathology data. All records of patients with recurrent skull base meningiomas were reviewed. Demographic data, presenting symptoms, surgical management, outcomes, and complications data were collected. Kaplan-Meier analysis was used to evaluate survival after reoperation. Logistic regression was used to evaluate for risk factors associated with complications. RESULTS Seventy-eight patients underwent 100 reoperations for recurrent skull base meningiomas. Seventeen patients had 2 reoperations, 3 had 3 reoperations, and 2 had 4 or more reoperations. The median age at diagnosis was 52 years, and 64% of patients were female. The median follow-up was 8.5 years. Presenting symptoms included cranial neuropathy, headache, seizure, proptosis, and weakness. The median time from initial resection to first reoperation was 4.4 years and 4.1 years from first to second reoperation. Seventy-two percent of tumors were WHO grade I, 22% were WHO grade II, and 6% were WHO grade III. The sphenoid wing was the most common location (31%), followed by cerebellopontine angle (14%), cavernous sinus (13%), olfactory groove (12%), tuberculum sellae (12%), and middle fossa floor (5%). Forty-four (54%) tumors were ≥ 3 cm in maximum diameter at the time of the first

HIPERTENSIÓN PULMONAR: IMPORTANCIA DE UN DIAGNÓSTICO PRECOZ Y TRATAMIENTO ESPECÍFICO

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Mónica Zagolin B., DRA.

2015-05-01

Full Text Available La hipertensión arterial pulmonar (HAP es una enfermedad crónica, que se caracteriza por el aumento de la resistencia vascular pulmonar (RVP a nivel de la arteriola pulmonar, que provoca una progresiva sobrecarga y posterior disfunción del ventrículo derecho (VD, que en etapas finales lleva a la insuficiencia cardiaca derecha, la cual sella su pronóstico. La HAP es más frecuente en mujeres jóvenes en plena edad productiva, siendo la supervivencia media de 2-3 años, antes de la aparición de terapias específicas. La base genética sugiere una herencia autosómica dominante con penetrancia incompleta, reconociéndose principalmente la afección del BMPR2. En la etiopatogenia se reconoce una alteración en las señales que controlan fundamentalmente el equilibrio vasocontrictor-vasodilatador a nivel del endotelio, con un desbalance hacia la proliferación y vasoconstricción, en las que están involucradas 3 vías patogénicas: La del Óxido nítrico (ON, de la Prostaciclina (PG y de la Endotelina (ET. El diagnóstico precoz de la HAP se asocia con una mejor supervivencia a largo plazo, por lo que su búsqueda ante un paciente con disnea, fatiga, dolor torácico y/o síncopes, así como en las poblaciones en riesgo, como son familiares en 1° con HAP, Esclerodermia y portadores de Hipertensión Portal, debería ser la estrategia de elección. La Ecocardiografía Doppler (ECO es la herramienta de pesquisa más utilizada en la práctica clínica actual. El diagnóstico debe ser confirmado mediante un cateterismo derecho, con mediciones directas de la presión arterial pulmonar, y debe realizarse prueba de vasoreactividad. El advenimiento de los tratamientos farmacológicos-HAP específicos ha provocado un cambio en la evolución natural de la enfermedad, existiendo hoy terapias orientadas a controlar las principales vías patogénicas involucradas: ON, PG, y ET. Los principales factores pronósticos que permiten guiar la terapia y la adici

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid-middle cranial fossa approach.

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Carlson, Matthew L; Copeland, William R; Driscoll, Colin L; Link, Michael J; Haynes, David S; Thompson, Reid C; Weaver, Kyle D; Wanna, George B

2013-11-01

The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid-middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers. Eighty-nine consecutive surgeries (86 patients, 59.3% women) were included. The mean age at time of surgery was 52.3 years, and the left side was affected in 53.9% of cases. The mean delay between symptom onset and diagnosis was 35.4 months, and the most common presenting symptoms were hearing loss (92.1%) and persistent ipsilateral otorrhea (73.0%). Few reported a history of intracranial infection (6.7%) or seizures (2.2%). Thirteen (14.6%) of 89 cases had a history of major head trauma, 23 (25.8%) were associated with chronic ear disease without prior operation, 17 (19.1%) occurred following tympanomastoidectomy, and 1 (1.1%) developed in a patient with a cerebral aqueduct cyst resulting in obstructive hydrocephalus. The remaining 35 cases (39.3%) were considered spontaneous. Among all patients, the mean body mass index (BMI) was 35.3 kg/m(2), and 46.4% exhibited empty sella syndrome. Patients with spontaneous lesions were statistically significantly older (p = 0.007) and were more commonly female (p = 0.048) compared with those with nonspontaneous pathology. Additionally, those with spontaneous lesions had a greater BMI than those with nonspontaneous disease (p = 0.102), although this difference did not achieve statistical significance. Thirty-two surgeries (36.0%) involved a middle fossa craniotomy alone, whereas 57 (64.0%) involved a combined mastoid-middle fossa repair. There were 7 recurrences (7.9%); 2 patients with recurrence developed

Abordajes transesfenoidales: primera opción para lesiones de región selar con criterio quirúrgico Transsphenoidal approaches: first option for injuries of the sellar region with surgical criterion

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Omar López Arbolay

2004-12-01

surgical approaches used for their solution are transcranial and transsphenoidal. We analized the results of sellar surgery during the last 8 years at "Hermanos Ameijeiras" Hospital through variables such as approach, type of injury, imaging and endocrinological characteristics, postoperative evolution, mortality and complications. 273 injuries were operated on (18 transcranial and 255 transphenoidal, 222 adenomas (150 functioning and 72 nonfunctioning, 27 arachnoidoceles, 13 fistulas of cerebrospinal fluid and other 11 tumoral injuries. The nonofunctioning adenomas were 70 macroadenomas and 2 microadenomas, whereas the functioning were 84 macroadenomas and 66 microadenomas. The control was always higher in microadenomas. 53,8 % of the fistulas were resolved. In patients with empty sella, the campimetric defect improved in 69,2 % and fistula was solved in 71,4 %. The evaluation by images in the postoperative of the rest of the injuries showed that of 6 craniopharyngiomas, total exeresis was attained in 5 predominantly cystic, and partial exeresis in one. The rest of the injuries were totally resected. Operative morbidity was 18,31 % in the whole series. It was significantly lower in the transsphenoidal approaches. Mortality was only present in transcranial approaches and it accounted for 0.73. The results in this study show that the transsphenoidal approaches are useful and reliable methods to treat sellar injuries.

Disfunção hormonal em lesões não hipofisárias das regiões selar e periselar Hormonal dysfunction of nonpituitary lesions from midline and perisellar area

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Ana Luíza Vidal Fonseca

2001-12-01

intracranial lesions from midline and parasellar area. METHOD: Forty-four patients were evaluated with nonpituitary intracranial lesions, who had images studies (computed tomography or magnetic resonance and preoperative basal hormonal level; 16 had preoperative hypothalamus-hypophysial function tests (megatests. These patients were divided in two groups. Group I - 34 lesions from midline: 11 craniopharyngiomas, 8 meningiomas, 3 germinomas, 3 tumors of sphenoid sinus, 2 empty sella syndrome, 2 pylocitic astrocytomas, 1 giant aneurysm, 2 mucoceles, 1 III ventricle diverticulum and 1 Rathke's cleft cyst; Group II - 10 lesions from parasellar area: 9 meningiomas and 1 giant aneurysm. RESULTS: In group I, 25/34 (73.5% patients showed laboratorial hormonal deficit (14 without clinical manifestations 18/34 (52.9% hyperprolactinemia (5 with galactorreia and 8 (53.3% showed growth hormone deficiency in 15 megatests avaliable in this group; 3 (8.8 % patients presented central diabetes insipidus (CDI. In group II, 6/10 (60% patients showed laboratorial hormonal deficit (5 without clinical manifestations, 1 (10% hyperprolactinemia and 1 growth hormone deficiency (single megatest realized in this group; no patient had preoperative CID. CONCLUSIONS: The presence of nonspecific or poorly valorized clinical manifestations, does not indicate absence of hormonal dysfunction; in this present serie, 19/38 (50% patients with laboratorial abnormalities, didn't show clinical manifestations. Hormonal dysfunction is frequent in sellar and perisellar nonpituitary lesions, specially involving midline.

Cirurgia endoscópica transnasal da região selar: estudo dos primeiros 100 casos Transnasal endoscopic surgery of the sellar region: study of the first 100 cases

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Jackson Gondim

2003-09-01

custos hospitalares. As desvantagens são a diminuição da profundidade de campo, a necessidade de constante controle do endoscópio e a necessidade de maior experiência com as técnicas de endoscopia.An endoscopic endonasal transsphenoidal approach to the sella was performed in 100 consecutive patients, with a follow up from 3 to 55 months: 57 females and 43 males, age ranging from 14 and 70 years. 76 cases pituitary adenomas: 22 were acromegaly (7 microadenomas and 15 macroadenomas; 21 null cell adenomas (3 microadenomas and 18 macroadenomas; 19 Cushing disease (11 microadenomas and 8 macroadenomas, 10 prolactinomas (6 microadenomas and 4 macroadenomas, and 4 LH adenomas (4 macroadenomas. In this serie, remission was achieved in 44.8% for macroadenomas, 60% for acromegaly, 27.7% for null cell adenoma, 50% for Cushing disease, 50% for prolactinomas and 50% for LH adenomas, and 81.4% for microadenomas 85% for acromegaly, 100% for null cell adenoma, 81.8% for Cushing disease, 66% for prolactinoma. We had also four craniopharyngiomas, four sphenoidal mucocele, three sphenoidal aspergillus, one Rathke cyst, one hypophysitis, one cavernous aneurysm, one encefalocele, one intrasellar meningioma, one intrasellar tuberculoma and a sphenoid fibrous dysplasia. In this series we also had six fistulas of the anterior base that were completely cured. We had a mortality of 2, one null cell giant adenoma in a 57 years old man and another patient, 38 years old, with a giant craniopharyngioma. The morbidity was: two cured meningitis, three cured fistulas, and two permanent diabetes insipidus. Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. The advantages of this technique have been represented by an easier access to the lesion, better visualisation and increased illumination of the surgical sites, microdissection of the tumor with maximum preservation of the pituitary function

The Functional Status of Hypophysis — ​Gonad Axis in Patients with Polycystic Ovary Syndrome

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Yu.M. Urmanova

2016-09-01

hyperandrogenemia and hyperprolactinemia. So, as compared to the group of control on the 14th day of cycle LH, FSH, and estradiol, progesterone, while free testosterone, DGEA were enhanced as compared to control data. In the second group of patients the reliable decline of pituitary hormones was also educed on a background of hyperandrogenemia and hyperprolactinemia while an ovarian function was within the normal limits. So, as compared to the group of control on the 14th day of cycle the LH, FSH, here free testosterone, DGEA and АМH levels were enhanced as compared to control data. The neuroimaging of hypophysis in patients with PCOS educed hyperplasia (adenomatosis of hypophysis in 49 from 120 (40.8 %, that can be explained by ovarian insufficiency in these patients. On the second place by incidence there was the syndrome of the empty sella (26 cases, 21.6 %, and on the third — the microadenoma of hypophysis in 16 persons (13.3 %. Conclusions. In the first group of patients with primary sterility the reliable decline of both pituitary and ovarian hormones was marked on a background of hyperandrogenemia and hyperprolactinemia. In the second group of patients the significant decline of pituitary hormones was also educed on a background of hyperanrogenemia and hyperprolactinemia, while an ovarian function was within the normal limits. In both groups of patients hypogonadotropinemia occurred combined with moderate hyperprolactinemia and hyperandrogenemia. Thus, the most expressed violations of the system of pituitary — ovarian function were found out in the first group of patients with PCOS with primary sterility, at that the significant decline of the functional status of pituitary — gonads axis was marked, namely decline of LH, FSH, estradiol and progesterone levels on the 14th day of menstrual cycle, that was confirmed by ultrasouns examination of uterus and ovaries by impoverishment of follicle vehicle of ovaries, anovulation signs. Thus, the most expressed violations of

Calculation of the Inelastic Scattering of Neutrons from Polyethylene and Water; Calcul de la diffusion inelastique des neutrons par le polyethylene et l'eau; Raschet neuprugogo rasseyaniya nejtronov poliehtilenom i vodoj; Calculo de la dispersion inelastica de neutrones por polietileno y agua

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Goldman, D T; Federighi, F D [Knolls Atomic Power Laboratory, General Electric Company, Schenectady, NY (United States)

1963-01-15

quelques precautions lorsque l'on fait l'integration numerique par rapport aux angles et aux energies. Le modele de diffusion a ete etendu aux calculs de la diffusion des neutrons par le polyethylene C{sub n}H{sub 2n}. On note des niveaux analogues a 0,089 eV, 0,182 eV, 0,354 eV et 0,533 eV. Les auteurs ont calcule les sections efficaces diffe- rentielle et totale pour la diffusion et ils ont constate que la seconde est en bon accord avec l'experience a la temperature du laboratoire. Ils ont calcule des noyaux de diffusion pour un certain nombre de temperatures et, chaque fois qu'il etait possible de le faire, ils ont compare les resultats aux experiences. De plus, ils ont calcule les spectres de flux de neutrons et les longueuts de diffusion en se fondant sur les equations de la physique des reacteurs. En comparant ces resultats et les donnees experimentales, on constate que ces mesures integrales donnent au moins des indications generales sur les caracteristiques du systeme de diffusion et qu'il conviendrait de les analyser en tenant compte des resultats detailles relatifs aux sections efficaces different tielles. (author) [Spanish] Nelkin propuso un modelo para calcular la dispersion de neutrones termicos por sistemas quimicos. Con arreglo a este modelo, la dinamica real del sistema dispersante se consideraba compuesta por una serie de movimientos oscilatorios cada uno de los cuales podia describirse por un hamiltoniano que conmuta con los hamiltonianos de los otros movimientos oscilatorios. Ello permitiria; expresar la seccion eficaz diferencial de dispersion en forma cerrada. Los autores han utilizado este modelo para calcular la dispersion de neutrones por el agua. Debe procederse con cierto cuidado al efectuar la integracion numerica respecto del angulo y de la energia. El modelo sella utilizado tambien para calcular la dispersion de neutrones por polietileno (C{sub n}H{sub 2n}). A 0,089 eV, 0,182 eV, 0.354 eV y 0,533 eV, se observan niveles analogos en el