摘要:

THE MOST PROMINENT previously reported clinical features of growth hormone (GH) and prolactin (PRL)-secreting pituitary adenomas associated with acromegaly have included the high incidence of galactorrhea in women and a generally more favorable response to dopamine agonist therapy. The authors analyzed a consecutive series of 62 acromegalic patients treated with transsphenoidal microsurgery. GH-PRL tumors were found in 30% of the patients. There was a significant difference in sex distribution between acromegalics with the GH-PRL tumor subtype and all other acromegalics. Women represented 73% of the GH-PRL immunostain subtype, as compared with the overall sex distribution of 33 women (53%) and 29 men (47%) for the entire series of acromegalic patients. Individuals with the GH-PRL subtype had significantly higher postoperative GH levels than those with the GH subtype, and significantly higher postoperative GH levels when compared with all other acromegalics with a variety of immunostain subtypes. Linear regression analysis of the pre- and postoperative GH data revealed that the increased postoperative GH levels in the GH-PRL immunostain subtype were independent of the invasiveness of the tumor and of sex of the subject. When the same linear regression technique was used, lower preoperative levels of thyroxine and thyroid-stimulating hormone were observed in the GH-PRL subtype. These data suggest inherent differences characteristic of tumors that secrete both growth hormone and prolactin.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

WE REPORT ON 21 patients surgically treated for intraparenchymal brain metastasis from sarcoma, including six osteosarcomas, four leiomyosarcomas, three malignant fibrous histiocytomas, two alveolar soft-part sarcomas, two Ewing's bone sarcomas, one extraskeletal osteosarcoma, one extraskeletal Ewing's sarcoma, and two unclassified sarcomas. Median survival after craniotomy was 11.8 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 15.7 versus 6.6 months for those with a Karnofsky performance score ≤ 70. Patients undergoing complete resection survived 14.0 versus 6.2 months for patients undergoing incomplete resection. Patients with evidence of lung metastases at the time of surgery survived 11.8 months, which was similar to the 10.5-month survival for patients with disease limited to the brain. The two patients with alveolar soft-part sarcoma are alive at 16 and 25 months after surgery. We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain and that patients with metastasis from alveolar soft-part sarcoma may have a relatively good prognosis if they are surgically treated. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis, whereas the presence of concurrent lung metastases is not a contraindication to surgery.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

TO EVALUATE THE prognostic significance of bromodeoxyuridine (BUdR) labeling index (LI) and to estimate tumor proliferative potential, BUdR LI was examined in 98 patients having a primary diagnosis of glioblastoma multiforme (GBM); 55 underwent infusion of 200 mg/m2of BUdR at the time of the primary resection and 49 underwent infusion at the time of the second resection. The tumors of six patients were labeled at both operations. The tumor specimens were stained with hematoxylin and eosin for histopathology and by immunohistochemical methods to determine the ratio of labeled to unlabeled cells, i.e., BUdR LI. The median BUdR LIs for the primary and recurrent GBM were significantly different at 6.8 and 2.6%, respectively (P< 0.0001). However, there was no significant association between BUdR LI at the first or second operation and survival (log rank,P= 0.12; Cox regression analysis,P= 0.91; log rank,P= 0.55; Cox regression analysis,P= 0.17, respectively). Patients who underwent a second operation within 10 months of the first operation had a lower BUdR LI than did patients with a longer interval between procedures (P= 0.078; Spearman rank correlation, 0.26). The aggressive biological behavior of GBM is dependent on complex cellular kinetics, not simply on the number of cells within the S phase of the cell cycle. Caution should be used when determining prognosis with BUdR LI in GBM.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

THE AUTHORS EVALUATED a series of proven intracranial cystic lesions prospectively. The relative signal intensities of these lesions on both T1- and T2-weighted sequences were correlated with the composition and viscosity of the cystic contents. Specimens were collected from 51 patients by cyst aspiration or at the time of surgery. Once a specimen was obtained, it was immediately sent for quantitative analysis of proteins, cholesterol, triglyceride, calcium, and blood by-products. In 30 patients, the cystic lesion was hypointense on T1 and hyperintense on T2 relative to white matter. The cystic content in this group of patients was a watery fluid that could be easily aspirated. In another 14 patients, the cystic lesion was either isointense or hyperintense on T1 and hyperintense on T2-weighted sequences. In this group of patients, the cystic contents were mild to moderately viscous and a wide bore needle or cannula was required for aspiration. In the remaining seven patients, the cystic contents were hyperintense (n = 4), isointense (n = 2), or hypointense (n = 1) on T1 but all were markedly hypointense on T2-weighted sequences. The contents of the cystic lesions in these seven patients ranged from pastelike to solid and had to be removed surgically. This study concludes that the observed T1- and T2-weighted signal intensities can predict the relative viscosity and the composition of intracranial cystic contents. This information is found to be quite useful in planning surgery and using appropriate instrumentation in the management of intracranial cystic masses.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

THE POPULATION IN eastern Finland has been stable for generations, causing a high degree of genetic isolation and providing excellent possibilities for follow-up studies. Of 91 families with familial intracranial aneurysms, 21 were randomly selected for prospective magnetic resonance angiography studies for intracranial aneurysms. Sixteen intracranial aneurysms were detected in 11 asymptomatic family members of a total of 110 studied. The prevalence of intracranial aneurysms among these familial intracranial aneurysm families is 10%, approximately 10 times higher than in the average population. Our findings suggest that family members of familial intracranial aneurysm families should be examined for intracranial aneurysms. Familial intracranial aneurysm may be a genetic disorder.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

QUANTITATIVE CINE-MODE MAGNETIC resonance imaging of the craniocervical junction was performed in 17 patients with a Chiari I malformation to evaluate cerebrospinal fluid (CSF) dynamics, including 8 patients who underwent surgery. The cine-mode magnetic resonance images of these patients were compared with those of 12 normal pediatric and adult subjects. The craniocervical junction was imaged by 16 cardiac-gated velocity-encoded images arranged in a cine loop. These images allowed the measurement of both the magnitude and direction of CSF velocity. Velocity measurements were made in four regions of interest–the foramen Magendie, the foramen magnum, and ventral and dorsal to the spinal cord at C2–and were plotted in relation to the cardiac cycle to produce a CSF velocity profile. All patients who underwent surgery had the same procedure: a posterior fossa craniectomy with C1 laminectomy, lysis of arachnoid adhesions, and duraplasty. Normal subjects had unobstructed flow around the craniocervical junction: a short period of cranial CSF flow was followed by a sustained period of caudal CSF flow. Patients with tonsillar herniation of more than 5 mm had obstructed CSF flow, decreased CSF velocity, and shorter periods of caudal CSF flow. These patients also had preferential cranial CSF flow as compared with the controls. Postoperatively, there was a substantial increase in both the velocity of CSF flow and in the period of caudal CSF flow in the foramen magnum. The postoperative changes mirrored the velocity profiles of the normal subjects. These changes in CSF velocity and direction correlated with a more normal-appearing foramen magnum, a reduction in syrinx size, and an improvement in symptoms.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

NEUROBEHAVIORAL OUTCOME AFTER craniocerebral gunshot wounds was evaluated in a prospective, 3-year, longitudinal follow-up of a consecutive case series of 13 children and adolescents. The younger group was composed of seven children, ages 1.5 to 4 years, and the older group contained six children, ages 5 to 14. Outcome measures included the Glasgow Outcome Scale and neuropsychological assessment of intelligence, language, motor, memory, attention, academic achievement, and adaptive behavior. Glasgow Outcome Scale scores at baseline indicated moderate and severe disabilities in 69 and 23%, respectively. At the 3-year follow-up, 85% had moderate disabilities but only 8% were severely disabled. Significant and persistent neurobehavioral deficits varied with developmental level at the time of cerebral insult. Intellectual functioning was clearly more impaired in children younger than 5 years of age at the time of injury than in older children. Cognitive and motor factors were most closely related to deficits in the younger group. Disability in older children and adolescents was associated with impaired attention, adaptive behavior, and behavioral disturbance. Disabilities appear to be at least as severe in our sample after cerebral gunshot wounds as in our studies of severe pediatric closed-head injury. At the time of follow-up, younger children sustaining gunshot wounds had slightly lower intelligence quotient scores and similar receptive language, expressive language, and gross motor scores compared with children with severe closed-head injury. The older gunshot wound patients were significantly more impaired than patients with severe closed-head injuries on measures of adaptive behavior and attention. Our findings suggest that early brain injury may not be associated with a more favorable prognosis than comparable injuries in older children and that the type of deficits observed vary with developmental level at the time of injury.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PULMONARY EMBOLISM (PE) IS a devastating complication in patients with traumatic spinal cord injury (SCI). Prophylactic measures such as venous compression hose or low-dose heparin are only partially protective in reducing the risk of venous thromboembolism and are contraindicated in some patients. Because of extended perturbations in fibrinolytic activity, catecholamine effects on platelet aggregation, increased activity of complement and acute phase reactants, abnormally high factor VIII concentrations, and persistent venous stasis with ongoing endothelial damage, the patient with an SCI remains at prolonged risk for venous thromboembolism. A retrospective 5-year review at the Medical Center Hospital of Vermont revealed seven patients with eight documented PEs (three fatal; 2.7%) in 111 SCI patients (6.3%). Six PEs (75%) occurred after discharge from the acute care facility. Median time to PE after injury was 78 days (range, 9–5993). Although comprising only 4% of all trauma admissions, SCI accounted for 31% of all PEs in the total trauma population (2525 patients). Beginning in July 1991, a new prophylaxis protocol was instituted, which included the percutaneous insertion of vena cava filters under local anesthesia in all SCI patients with paraplegia or quadriplegia. Fifteen patients have undergone the insertion of titanium filters. Impedance plethysmography was performed weekly to detect deep venous thrombosis. No complications were associated with vena cava filter insertion. No patients developed deep venous thrombosis during their acute hospitalization (median, 22 d), and no patients have developed PE after filter insertion. A follow-up deep abdominal Duplex scan of the vena cava was performed, with a 30-day patency of 100% and 1-year patency of 81.8%, by the use of life table analysis. The lower patency rate at 1-year follow-up is felt to represent the trapping of thrombus. We conclude that prophylactic vena cava filters are safe and effective in patients with traumatic SCI.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

USING DATA FROM the Second National Acute Spinal Cord Injury Study (NASCIS II), the authors sought to characterize the role of surgery in the management of traumatic spinal cord injury and to examine the interaction between pharmacological treatment and surgery. Patients who did not undergo surgery had more severe spinal cord injuries initially than those who had surgery. However, no differences in neurological improvement at 1-year follow-up were found between those who underwent surgery and those who did not. The results suggest that either early surgery (≤ 25 hours after injury) or late surgery (> 200 hours) may be associated with increased neurological recovery, particularly motor function, but these results are equivocal. Surgery was not shown to interact with pharmacological treatments, indicating that the effect of drug treatment in NASCIS II, reported elsewhere, is not influenced by surgery. Other independent variables that best predicted improvement in motor score were age of 25 years or younger, incomplete injury, and lower baseline emergency department neurological scores. This study does not provide clinically relevant evidence concerning the efficacy of timing or the value of surgery in treating patients with spinal cord injuries. A randomized study on the timing and efficacy of spinal cord surgery is needed to obtain valid comparisons of the efficacy of surgical treatments.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

WE DESCRIBE OUR experience with total craniospinal decompression along the entire neuraxis, extending from the brain stem to the cauda equina, in seven patients with achondroplasia. These patients presented with clinically significant compression at multiple levels. In these patients, there were focal areas of complete myelographic block, typically at the cervicothoracic or thoracolumbar junction, as well as diffuse narrowing of the entire spinal subarachnoid space. In some, there were further complications of basilar impression, Arnold-Chiari malformation, or syringomyelia. Total craniospinal decompression was completed in either one or two stages. Only a small minority of our patients with achondroplasia had critical stenosis over this many levels, requiring total craniospinal decompression. However, with proper preparation and technique, we found that patients can tolerate even such an extensive decompressive procedure and benefit from surgery without suffering postoperative spinal instability.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID