Biomedical subjects
Publications and source records attributed to E R Laws.
The authors review the present knowledge of the hypothalamic-pituitary endocrine axis. The physiology and pathophysiology are discussed along with outlines of standard approaches to diagnosis of disorders. An appendix of useful provocative tests is included.
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A 48-year-old woman with an extensive pituitary adenoma developed atlanto-occipital instability secondary to erosion of the base of the skull by the tumor. The pathophysiology, diagnosis and surgical treatment are described.
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Thirty-four patients with pathologically confirmed primary pineal tumors were evaluated at the Mayo Clinic from 1923 through 1976. All tumors were of germ cell or pineal cell origin. Most patients were adolescent boys with subacute increased intracranial pressure and Parinaud's syndrome. Hypothalamic symptoms were surprisingly infrequent. Direct surgical intervention was associated with high mortality, but has been more successful in recent years.
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A study of 26 hemangiopericytomas of the meninges revealed that the histologic appearance--including ultrastructural features--was similar to that of hemangiopericytomas of soft tissues. Both sexes were affected, and occurrence was most frequent in the adult years, with no symptoms specific for the lesions. The lesions were characterized by an aggressive course, with recurrence in 80% of the patients, and metastases in 23%; thus, the importance of recognizing the lesion pathologically is emphasized.
Transseptal, transsphenoidal pituitary surgery is safe and effective in the management of various problems associated with the region of the sella turcica. This series include 285 operations on 272 patients treated from Sept. 1, 1972, to Sept. 1, 1976. The operative mortality was 1.75%. In every patient, the anatomy should be assessed preoperatively by polytomograms of the sella and the sphenoid sinus and by bilateral carotid angiography. The operating microscope and intra-operative x-ray control with the image-intensifier are essentials. Pneumoencephalography is performed whenever the possibility of an empty sella or arachnoidal cyst exists and when angiography does not satisfactorily outline the suprasellar extension of large pituitary tumors. Computerized tomographic scanning is also of value. A new group of pathologic problems, namely microadenomas (tumors less than 1 cm in diameter), has now become amenable to transseptal surgical management. This series includes a group of 50 patients with microadenomas: 45 with functioning pituitary adenomas and 5 with nonfunctioning pituitary adenomas. The transfrontal intracranial surgical approach also has specific indications. This choice is determined by the anatomy and the extent and nature of the pathologic lesion. The rhinologic concepts of exposure and reconstruction are modifications of the "maxilla-premaxilla" (Cottle) approach to the nasal septum. This allows direct midline access to the sphenoid sinus and sella turcica while preserving both the caudal end of the nasal septum and the anterior nasal spine, thereby minimizing rhinologic airway and cosmetic complications. We believe that, by combining the talents of the neurosurgeon, endocrinologist, neuroradiologist, ophthalmologist, and rhinologist, this procedure can be offered to patients with a wide range of disorders and excellent results may be anticipated.
Twenty-two of 32 patients with Cushing's disease seen at the Mayo Clinic during a 3-year period were carefully studied radiologically (triaxial spiral tomograms of the sella and bilateral carotid arteriograms with magnification and subtraction techniques). Eighteen of these 22 pat-ents had radiologic evidence of small pituitary gland tumors and underwent transsphenoidal microsurgical exploration of the pituitary. A microadenoma (less than 10 mm) was found in 17 of the 18 patients. Hypercortisolism was corrected, and a clinical remission occurred in 16 of the 18 patients; the hypercortisolism persisted in 2 patients. A period of hypocortisolism occurred after removal of the pituitary tumor in all patients who experienced a remission. Remissions have been associated with normal anterior pituitary and adrenocortical function in a large percentage of patients who were adequately studied 6 months or more after pituitary surgery.
There has been a recent, rapid increase in the number of pituitary adenomas diagnosed in women of childbearing age in Olmsted County, Minnesota. The incidence rates in men of all ages and in women aged 45 and over have remained stable and are similar to rates reported from elsewhere. Since 1970 the mean annual incidence per 100,000 women aged 15 through 44 years has been 7.1, whereas it was 0.7 in the population of the same age and sex during the period 1935 through 1969.
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A technique of organ culture based on a three-dimensional porous matrix was employed for chemotherapeutic trials on human malignant astrocytomas. The method allows neoplasms to retain the morphological identity and the histological characteristics they possess in vivo. Success in culture was greatest with high-grade astrocytomas, the majority of which showed definite infiltration of the matrix. Low-grade tumors, if viable, did not display active penetration. Drug trials on eight malignant astrocytomas included BCNU, methyl CCNU, VP 16-213, and Solu-Medrol. Cyanide and luciferase were used as experimental metabolic toxins. Evidence of cytotoxicity was assesed qualitatively by histological changes on microscopic preparations of treated and control cultures. Microfluorometric determinations of reduced nicotinamide adenine dinucleotide (NADH) were applied to these trials in an effort to detect a quantitative biochemical index of drug effects. A variable rise in although correlation with microscopic changes was inconsistent. Because of its potential merits, organ culture may be a valuable tool for further work on pharmacological management of malignant gliomas.
A review of recent experience with transsphenoidal for lesion in and about the sella turcica establishes the value of this approach for the management of patients which visual loss. The lesions encountered consisted of pituitary adenoma in 45 cases, craniopharyngioma in 10 cases, and miscellaneous tumours involving the sella in the remaining seven cases. Sixty of the 62 patients in this series had quantitative determination of preoperative and postoperative visual status; after surgery, vision was improved in 81%, unchanged in 11%, and worse in 5%. Two patients (3%) died during the immediate postoperative period before their visual status could be evaluated.
The authors report a case of pituitary apoplexy occurring several hours after carotid angiography. The event was associated with stupor, focal headache, and left hemiparesis. Repeat angiography demonstrated intracranial occlusion of the right internal carotid artery. At surgery, a hemorrhagic pituitary adenoma was found to be compressing the internal carotid artery, and the removal of the tumor resulted in restoration of flow. The mechanism, presenting symptoms and signs, and treatment of pituitary apoplexy causing compression of a major vessel are discussed.
Transcutaneous stimulation (TCS) has been reported to modify peripheral blood flow, skin temperature, blood pressure, and heart rate, all of which are under the influence of the autonomic nervous system (ANS). In 20 patients with intractable pain and in 10 control subjects, TCS was not found to alter significantly any of the observed properties of ANS function of control subjects or patients, except to decrease skin impedance in the patient group after the stimulation. Patients reporting pain relief during TCS were found to have significantly higher systolic blood pressure under all test conditions than patients reporting no pain relief (p less than 0.05). No other significant differences were found between these two groups. Finally, in the patients, no significant localized autonomic changes were demonstrated in the painful area by comparison with the homologous body part.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.