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Biomedical subjects

C B Adams

Publications and source records attributed to C B Adams.

At least 55 records · Page 3Linked to original sources
PubMed1988

The management of pituitary tumours and post-operative visual deterioration.

The indications and results of transsphenoidal surgery for pituitary adenomas are analysed. The advantages and disadvantages of Bromocriptine and radiotherapy are considered. Transsphenoidal surgery does not damage pre-existing pituitary function. It produces excellent results in micro and mesoadenomas, curing about 70-80% of patients irrespective whether the tumour produces ACTH, prolactin or growth hormone. Moreover there is a very small relapse rate. Macroadenomas of non-functioning type are also well treated by transphenoidal surgery, with a small recurrence rate as judged by CT scan follow-up. But macroadenomas secreting prolactin or growth hormone are less effectively treated by transsphenoidal surgery, only about 40% being cured. Invasive macro prolactinomas are not helped by surgery and should be treated with Bromocriptine and radiotherapy. Radiotherapy should be used sparingly and has inevitable complications. Post-operative delayed visual deterioration is caused either by recurrent tumour or radiotherapy. There is no good evidence to support the secondary empty sella syndrome as a cause of such delayed visual deterioration.

Adenoma↗
PubMed1988

The value of accurate clinical assessment in the surgical management of the lumbar disc protrusion.

One hundred patients with lumbar disc protrusions were studied. Thirty six "control" patients were admitted in the same time period with low back pain and sciatica but with subsequently "normal" myelograms and no surgery. The aim of this paper was to relate history and clinical signs to the myelograms and surgical findings. Ninety nine per cent of our patients presented with sciatica (controls 94%). The most frequently found sign in patients with a disc protrusion was reduction of ipsilateral straight leg raising (98%). However, 55% of controls also showed this sign. There were three signs that, when present, particularly indicated a disc protrusion; "crossed straight leg raising" (pain on contralateral straight leg raising), measured calf wasting and impaired ankle reflex: the latter being especially indicative of an L5-S1 disc protrusion. There were two further important signs, weakness of dorsiflexion of the foot and scoliosis of the lumbar spine. However, such signs occurred in about half the patients and so clinical diagnosis in the remaining half depended on obtaining a good history of sciatica, and paying due regard to severity of the pain, the mobility of the patient, the ability and desire to work and the overall personality. Satisfactory results of surgery simply depend on finding and removing a definite disc protrusion. Using these methods of selection, 98% have returned to their original employment, 86% within 3 months of the operation. For a patient with no abnormal signs and a normal myelogram, surgical treatment should not be advised.

Adult↗
PubMed1988

Modified hemispherectomy for epilepsy: early results in 10 cases.

Early outcome results for 10 cases of modified hemispherectomy are presented. All patients had a history of infantile hemiplegia and intractable epilepsy. Pre- and postoperative measures for seizures and motor and cognitive and behavioural functioning are described. Early results are encouraging with no mortality and a low rate of complications. There was a complete cessation of seizures in seven patients and a considerable reduction in seizure frequency in two. Motor functioning was largely unaffected. Behaviour problems tended to improve at the cessation of seizures. IQ scores did not deteriorate as a consequence of operation and some patients showed considerable gains in IQ with the passage of time. Details of cognitive functioning are described.

Adolescent↗
PubMed1987

Misinterpretation of prolactin levels leading to management errors in patients with sellar enlargement.

Serum prolactin concentrations and clinical features were correlated with the histopathologic diagnosis in 128 patients, without acromegaly or Cushing's syndrome, referred for surgical treatment of a presumed pituitary adenoma. A serum prolactin concentration of more than 8,000 mU/liter was always due to a prolactin-secreting adenoma. Prolactin levels of less than 8,000 mU/liter occurred with a variety of pathologic diagnoses. Fifteen patients had lesions other than pituitary adenomas, most commonly intrasellar craniopharyngioma; 10 of these had modest hyperprolactinaemia (maximum, 5,260 mU/liter) and four had received inappropriate bromocriptine therapy. Adenomas that were not prolactinomas frequently caused mild hyperprolactinaemia, although this was usually less than 3,000 mU/liter; three of these patients, however, had serum prolactin concentrations greater than this (maximum, 8,000 mU/liter). If the serum prolactin concentration is less than 3,000 mU/liter in the presence of significant pituitary enlargement, surgical removal is essential for both diagnosis and treatment since only prolactin-secreting adenomas are likely to shrink with dopamine agonist therapy. A serum prolactin concentration between 3,000 and 8,000 mU/liter is consistent with any diagnosis, whether the fossa is greatly enlarged or not, and great care must be taken with dopamine agonist therapy in such patients.

Adenoma↗
PubMed1987

Factors in the outcome of transsphenoidal surgery for prolactinoma and non-functioning pituitary tumour, including pre-operative bromocriptine therapy.

Radical transsphenoidal surgery in 58 patients with large non-functioning pituitary tumours relieved pressure symptoms and disconnection hyperprolactinaemia without loss of pituitary function, and verified the diagnosis. Pre-operative bromocriptine did not cause any shrinkage of non-functioning tumours (n = 8), even up to 48 weeks. Thirty-two patients not given postoperative radiotherapy are being followed-up, and although two show minor CT scan evidence of tumour regrowth, for the others the delay in radiotherapy is enabling reproduction where required. In 20 patients with non-invasive macroprolactinomas radical surgery caused no loss of pituitary function but cured eight, of whom one has relapsed; none of eight invasive prolactinomas was cured by surgery. Pre-operative bromocriptine caused marked size reduction in seven of seven macroprolactinomas, but if continued beyond 6 weeks induced tumour fibrosis and uneven shrinkage which made surgery dangerous and unproductive. Selective transsphenoidal surgery relieved hyperprolactinaemia in 70% of patients with meso- (n = 15) or microprolactinoma (n = 24) usually without loss of pituitary function: the relapse rate was 1 per 88 patient years of follow-up. Invasive prolactinomas, and macroprolactinomas showing uneven shrinkage with a short (up to 4 weeks) course of bromocriptine should have radiotherapy rather than surgery, while the patients most suited to surgery are those with mesoprolactinomas, or some macroprolactinomas with compact intrasellar shrinkage after short-term bromocriptine. Microprolactinomas generally did not benefit from surgery as compared to conservative therapy. In none of the tumour groups were the surgical findings an accurate predictor of postoperative pituitary function.

Adenoma↗
PubMed1987

Pituicytoma (pilocytic astrocytoma). Case report.

Tumors of the posterior pituitary are rare and the previous nomenclature has been confusing. A 40-year-old man presented with visual failure and disconnection hyperprolactinemia (830 mU/liter) due to a large invasive pituitary tumor shown to be a pituicytoma (pilocytic astrocytoma). Its astrocytic nature was confirmed by positive immunostaining for glial fibrillary acidic protein and the finding of cytoplasmic filaments on electron microscopy. This case report contains the pathological description of a pituicytoma and illustrates that a non-adenomatous pituitary lesion may masquerade as a pituitary adenoma. Large pituitary lesions associated with serum prolactin concentrations of less than 3000 mU/liter require early surgical biopsy.

Adult↗
PubMed1986

Synaptic connections of axo-axonic (chandelier) cells in human epileptic temporal cortex.

The human temporal cortex contains a type of interneuron, identified by Golgi impregnation which, like the axo-axonic or chandelier cells found in animals, establishes Gray's type II synaptic contacts exclusively with the axon initial segments of pyramidal cells. Each terminal segment is composed of 3-12 boutons to form a "chandelier"-like appearance. For the two human axo-axonic cells analysed in this study we could identify 269 and 86 bouton rows respectively, which represents an equivalent number of postsynaptic pyramidal cells. A terminal bouton row from one of these Golgi-impregnated cells was shown to be in synaptic contact with the axon initial segment of a Golgi-impregnated pyramidal cell. The very specific nature of the target of axo-axonic cells, together with their highly divergent axonal arborization, means that they are ideally placed to control the output of a large population of pyramidal cells. Since previous studies in animals have shown the GABAergic nature of axo-axonic cells it is possible that human axo-axonic cells could be involved in the generation of epileptic activity or in the control of its propagation.

Adolescent↗
PubMed1986

Effect of bromocriptine treatment on the fibrous tissue content of prolactin-secreting and nonfunctioning macroadenomas of the pituitary gland.

We performed a quantitative study using a point-counting technique at the light microscope level of the fibrous tissue content of PRL-secreting and nonfunctioning pituitary macroadenomas from patients treated or untreated with bromocriptine (BC) before surgery. There was a significant increase in the fibrous tissue content of PRL-secreting, but not nonfunctioning, tumors after BC treatment. The extent of the increase in fibrous tissue in prolactinomas correlated with the duration of treatment with BO.

Adenoma↗
PubMed1986

The radiologic investigation of temporal lobe epilepsy. Value of high resolution CT with temporal orientated sections.

The value of high resolution computed tomography of the temporal lobes using temporal lobe orientated sections and intrathecal contrast is described. The results of this technique are correlated with the pathologic findings in 13 patients subsequently proven to have temporal lobe gliomas. These patients all presented with drug resistant temporal lobe epilepsy and underwent temporal lobectomy. This technique was successful in detecting the tumours in 11 of 13 patients. The average size of the tumours was just over 2 cm. The importance of detecting these small tumours is emphasised because of the profound effect this has on management.

Brain↗
PubMed1985

The effect of dopamine agonist therapy on large functionless pituitary tumours.

Fifteen patients (12 male) with large pituitary tumours and serum prolactin levels below 1000 mU/l were given dopamine agonist therapy (bromocriptine, mesulergine or pergolide) for a mean of 9 months (range 3-36 months). Serum prolactin became undetectable in all. Despite this, significant suprasellar extensions and any associated neurological defect remained in 14 patients, who therefore were referred for surgery. In one patient there was evidence of spontaneous pituitary infarction unrelated to dopamine agonist therapy. At operation 12 patients had apparently functionless pituitary adenomas which failed to immunostain for prolactin, one had an epidermoid cyst and one a Rathke's pouch cyst. We conclude that patients with large pituitary tumours and only a mildly elevated serum prolactin are unlikely to have prolactinomas, and that such tumours are not likely to show significant tumour shrinkage with medical treatment with dopamine agonists.

Adenoma, Chromophobe↗
PubMed1984

Cerebellar mass caused by Candida species. Case report.

The authors report a case of cerebellar pseudotumor caused by a Candida species without evidence of any underlying systemic disorder or extracranial disease. Total removal followed by treatment with amphotericin B resulted in a favorable outcome.

Adolescent↗
PubMed1984

CSF smooth-muscle constrictor activity associated with cerebral vasospasm and mortality in SAH patients.

Cerebrospinal fluid (CSF) was collected preoperatively (by lumbar puncture) or perioperatively (by lumbar or ventricular drain) from 32 patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms. Samples were also obtained from six control patients without evidence of subarachnoid blood. Smooth-muscle constrictor activity in the CSF was measured by bioassay using the isolated rat stomach fundus preparation. Concentrations of unidentified smooth-muscle constrictor substances were considerably greater in CSF from a group of seven patients with evidence of severe angiographic vasospasm and/or delayed ischemic deficits who died (73.8 +/- 39.7 nmol/liter prostaglandin E2 (PGE2) equivalents), as compared to 25 other SAH patients who survived (6.5 +/- 1.4 nmol/liter PGE2 equivalents), and six control patients (1.17 +/- 0.34 nmol/liter PGE2 equivalents). The data suggest that there is a relationship between smooth-muscle constrictor substances in the CSF after SAH and both the degree of angiographic vasospasm and the outcome. It is possible that this relationship might be exploited clinically.

Humans↗
PubMed1983

Pituitary adenomas: immunohistology and ultrastructural analysis of 118 tumors.

An analysis is presented of the immunohistological and ultrastructural features in a series of 118 surgically removed pituitary adenomas all of which were studied immunohistologically using antisera to growth hormone (GH), prolactin (PRL) ACTH, beta FSH, beta LH and beta TSH, and 75 of which were studied ultrastructurally. Results were analysed according to the mode of presentation of patients. Forty-one (35%) of the tumours were from patients with acromegaly or gigantism, ten (9%) from patients with Cushing's syndrome or Nelson's syndrome, 19 (16%) from patients with clinical features associated with hyperprolactinaemia and 48 (40%) from patients with space occupying lesions which appeared clinically to be overtly endocrinologically functionless. By light microscopy, using the immunoperoxidase (PAP) technique, immunoreactive GH was demonstrated in all the tumours from patients with acromegaly or gigantism, immunoreactive ACTH in all tumours from patients with Cushing's syndrome or Nelson's syndrome and immunoreactive PRL in 95% of tumours associated with effects of hyperprolactinaemia. Forty-five percent of the tumours from acromegalic patients contained some PRL-positive cells as well as GH-positive cells. Among the tumours which appeared clinically to be endocrinologically functionless were three tumours (from males) uniformly stained for immunoreactive PRL. Of the remainder, 60% were negative for immunoreactive hormones and 40% contained small numbers of cells which were positive for a variety of immunoreactive hormones. ACTH-cell and PRL-cell tumours had ultrastructural features as described in previous studies. Fifty percent of GH-cell tumours examined at the EM level contained fibrous bodies, while in the remainder these structures were not identified. Tumours with fibrous bodies were more likely to contain PRL as well as GH with immunoperoxidase. All tumours that were endocrinologically functionless and which were examined at the EM level contained secretory granules. Oncocytic change was common in these tumours. No ultrastructural differences were observed between those which contained immunoreactive hormones by light microscopy and those which did not.

Acromegaly↗