[Trigeminal neuralgia -- surgical technique (author's transl)].
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Biomedical subjects
Publications and source records attributed to H Mogami.
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Four cases of pituitary adenoma with intratumoral hemorrhage were studied endocrinologically. 1) It would be suggested that ACTH and TSH secretion of these cases was strongly impaired but LH, FSH and PRL secretion was fairly preserved immediately after hemorrhagic episode. 2) Two of these four cases revealed normal TSH secretion and normal thyroid function following the period of excessive TSH secretion and impaired thyroid function.
One case with Wallenberg's syndrome followed by the neck clipping of the posterior inferior cerebellar aneurysm was reported. The patient was 49 years old female with the subarachnoid hemorrhage, who had previously no history of the cardiovascular disease. The vertebral angiogram revealed a saccular aneurysm of the left vertebral artery at the origin of the posterior inferior cerebellar artery. The preoperative neurological examination were normal, except for the slight degree of the meningeal irritation. The surgical intervention was successfully performed on 39th day after the subarachnoid hemorrhage. Postoperative course was eventful, presenting the typical Wallenberg's syndrome, which was complicated the accompanying signs. The troublesome accompanying signs were chiefly automatic respiratory dysfunction (sleep-induced dyspnea), autonomic dysfunction (Horner's syndrome, perspiration, hypertension), and restless confusion. The postoperative vertebral angiogram showed the obliteration of the aneurysm and the sufficient circulation of the vertebrobasilar system, especially the posterior inferior cerebellar artery. The mechanism of "sleep-induced dyspnea" was discussed in detail from the literatures. In addition to the above mentioned, it should be stressed that the recognition of "sleep-induced dyspnea" and the other accompanying signs are important for the treatment of the patient with the brain stem lesion.
Fifty-six cases of sellar and suprasellar tumors were examined endocrinologically before and 3 weeks after surgery. 1) Hyporeactive cases of GH & ACTH were more frequently found in pituitary adenoma (100% and 23% respectively than in craniopharyngioma (86% and 14% respectively) before surgery. 2) GH secretion was impaired 3 weeks after surgery in all the cases. 3) ACTH secretion impaired preoperatively in 5 cases of pituitary adenoma improved in 3 cases 3 weeks after surgery. 4) Hyporeactivity of LH, FSH and TSH was found more frequently after surgery than before. 5) Almost all the cases of tuberculum sellae meningioma were endocrinologically normal before surgery. 6) ACTH, LH, FSH and prolactin secretion in cases of tuberculum sellae meningioma was not impaired after surgery, but TSH secretion in these cases became hyporeative in 4 of 5 cases after surgery.
1) Pituitary function of 9 cases of tuberculum sellae meningioma was examined, before and after surgery (3 weeks, 1 year and 2 years after surgery). 2) In all cases ACTH, LH, FSH and prolactin responses were normal throughout pre- and postoperative courses. 3) GH and TSH were normoreactive in almost all cases preoperatively. Postoperatively GH and TSH were hyporeactive 3 weeks after surgery, but recovered to normal 1 or 2 years after surgery.
The anterior pituitary hormone secretion of 5 patients with ectopic pinealoma in the chiasmal region was studied. 1) GH response in ITT was hyporeactive in all cases. Two of 4 cases showed hyporeactive ACTH secretion in Metyrapone test. Two of 5 cases decreased TSH secretion in TRH test. Prolaction secretion was normal in all 5 cases. All 5 cases showed hyporeactive FHS response. LH secretion was negligible in 2 of 5 cases, but other 3 cases showed abnormal LH response in LH0RH test with abnormally high basal level and no response to LH-RH. 2) In 3 cases with abnormal LH response blood HCG was determined and identified by radio-immuno-assay using HCG-beta-subunit antiserum. 3) Precocious puberty was recognized in 2 boys with identified blood HCG. 4) Abnormally high blood LH levels in those 3 cases were significantly decreased after lineac irraiation.
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1) Nine of 25 cases of chromophobe adenoma revealed abnormally high plasma prolactin level. The plasma prolactin level of these 9 cases ranged from 5300 to 15000 ng/ml, and those of other 16 cases ranged from negligible to 53 ng/ml. 2) Five cases with abnormally high plasma prolactin level had a poor clinical course. 3) Quantitative determination on PEG according to our own method showed that tumor size of these patients with abnormally high plasma prolactin level was larger than that of relatively lower plasma prolactin level. 4) Three of all 25 cases of chromophobe adenoma were histologically diagnosed as pleomorphic. Each of those three cases showed abnormally high plasma prolactin level.
1) Pituitary hormone secretion of 14 acromegalic patients was studied before treatment. Incidence of hyporeactive response was 0%, 43%, 29%, 71% and 9% in ACTH, LH, FSH, TSH and PRL respectively. 2) Relatively higher incidence of hyporeactive TSH response in TRH test seems to be characteristic in acromegalic patients. 3) Six of 13 acromegalic patients examined on blood PRL level revealed relatively high blood PRL level over 50ng/ml.
Serum GH levels were measured in 14 acromegalic patients in ITT, TRH test, LH-RH test, arginine test, OGTT, exercise test, CPZ test and PEG. More than 50% increase of serum GH level was observed in 3 of 13 ITT, 8 of 14 TRH test, 6 of 14 LH-RH test, 2 of 12 arginine test, 2 of 9 OGTT and 2 of 7 PEG. Only 2 out of 7 cases showed more than 50% decrease of serum GH level in CPZ test. Striking GH responses were observed in TRH and LH-RH test. Five of 14 cases showed more than 100% increase of serum GH level in TRH test but they did not have a significant response to LH-RH. Four of 14 cases also had more than 100% increase in LH-RH test with no significant response to TRH. The rest of the cases (5 cases) did not have marked response to either TRH or LH-RH. According to these results, serum GH responses of acromegalic patients could be devided into 30 types, 1) TRH responding type, 2) LH-RH responding type, 3) no response type.
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