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Biomedical subjects

R Oeckler

Publications and source records attributed to R Oeckler.

29 records · Page 2Linked to original sources
PubMed1988

Insulin hypoglycemia test and releasing hormone (corticotropin-releasing hormone and growth hormone-releasing hormone) stimulation in patients with pituitary failure of different origin.

To investigate the efficacy of endocrine evaluation in diagnosing and localizing the cause of anterior pituitary failure, 17 patients with suprasellar space-occupying lesions, 4 patients with intrasellar tumors, 8 patients with no detectable anatomical lesion, 1 patient with posttraumatic failure and 1 patient with septooptical dysplasia were investigated. Endocrine evaluation consisted of measuring adrenocorticotropic hormone (ACTH), cortisol, and growth hormone (GH) levels during insulin hypoglycemia test (IHT) and after administration of corticotropin-releasing hormone (CRH) and growth hormone-releasing hormone (GRH). In addition, basal prolactin levels, gonadal and thyroid function were evaluated. The results showed that 4 of 17 patients with suprasellar tumors had normal ACTH and GH responses during IHT and after releasing hormone (RH) administration. Five of these patients had a normal ACTH or cortisol rise but no GH response during IHT. All 5 had a normal ACTH and 3 had normal GH rise after RH. Seven patients with suprasellar tumors had no ACTH or GH response during IHT, but all had an ACTH response to CRH. Only 3 of this group had a GH response to GRH. There was one exception of a patient who showed a GH and ACTH rise during IHT but only a blunted ACTH and no GH rise after RH administration. Four patients with pituitary failure and no demonstrable lesion had an ACTH rise after CRH but no GH rise after GRH, whereas in 3 patients with isolated ACTH deficiency no ACTH rise after CRH was seen. In 4 patients with nonsecreting pituitary tumors normal ACTH responses to IHT and CRH were seen, whereas GH rose during IHT only in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Postoperative controls in surgically treated hormonactive pituitary adenomas by use of magnetic resonance imaging.

The search of reliable imaging methods to detect the substrate for persisting hypersecretion in patients operated on for hormonactive pituitary adenoma prompted us to study the possibilities of the newly available Magnetic Resonance Imaging (MRI) technique in this regard. Pre- and postoperative MRI-studies where performed in 5 patients with persisting GH excess following transsphenoidal surgery as well as in 3 patients with micro- and 2 patients with macroprolactinomas. The MRI-findings were correlated with the results of the endocrinological examinations. Two acromegalic patients and three cases with microprolactinomas, who were successfully operated upon as defined by the functional criteria were also included to obtain a baseline for normal postoperative findings. The MRI-study was positive in all of the five patients with persisting GH-overproduction. In prolactinomas, the substrate of hypersecretion could only be detected, when the PRL-value exceeded 2,000 microU/ml. MRI may present an important diagnostic method for evaluating further treatment options in patients with remaining hormonal hypersecretion following transsphenoidal adenomectomy, particularly with regard to a second surgical approach.

Acromegaly↗
PubMed1987

Results of surgical treatment in patients with arachnoid cysts.

A retrospective study of 35 patients operated upon for arachnoid cysts during the last 10 years was carried out. In 19 patients treated by craniotomy, membrane resection and drainage into the basal cisterns, clinical improvement could be noted in 13 cases. Correspondingly on the CT-controls the cysts were found to have disappeared in two cases and were reduced in size in seven patients. In 11 patients, however, who were initially treated by a shunting procedure, seven patients became free of symptoms. Postoperative CT-controls showed in three cases a significant reduction of the size of the cyst, which remained unchanged in two other cases. In five patients with the combination of a nonspace-occupying arachnoid cyst and subdural effusions, drainage of the latter only was sufficient to relieve the clinical symptoms. The prominent findings were the high complication rate of the primary or secondary shunting procedures (48%), as well as the close correlation between the clinical outcome and the postoperative CT-controls.

Arachnoid↗
PubMed1987

[Magnetic resonance imaging in craniopharyngiomas. The differential diagnosis of cystic intra- and suprasellar space-occupying lesions].

Seven patients with confirmed craniopharyngiomas were examined via magnetic resonance imaging. The various tumour components (whether solid, cystic or calcified) were evaluated separately. Three types of cysts were observed that can be distinguished by their signal intensity in various pulse sequences. This could be explained largely by an analysis of the T1 and T2 image contrast. The reason for the various types of cysts is determined by their cholesterol content. MR imaging is not as useful as CT for demonstrating the solid and calcified portions of the tumour and this reduces its value in diagnosing the type of tumour. Against that, it is superior with regard to separating the tumour from its neighbouring structures. The differential diagnosis, which must be considered in using MR, is summarised in a table at the end of the paper.

Craniopharyngioma↗
PubMed1987

[Psychopathologic symptoms and personality traits in patients with florid acromegaly].

Important technical and clinical progress has been achieved in neuroendocrinological diagnostic investigations in recent years. Patients with active acromegaly and without a total loss of pituitary anterior lobe function can now be defined. With the help of neuroradiological investigations the intra-, supra- and parasellar extent of the adenoma can be determined. For the following study we selected patients with active acromegaly without a significant reduction of the other pituitary anterior lobe functions and with intrasellar adenomas. 31 patients with active acromegaly were examined before the operation. These patients have uniform psychopathological symptoms including loss of drive, affective disorders such as dejection, brooding, and irritability, and increase in appetite and loss of libido. The psychopathological symptoms are dependent neither on the level of the increased growth hormone nor on hyperprolactinemia. The higher cortical functions are intact. No disorders of intelligence or memory can be found. Disturbances of mental functions are manifested as disorders of concentration and fatigue. Personality traits were strikingly uniform. Their personalities are characterized by conscientiousness, reliability and industriousness. Some patients are also anxious and lacking in self-confidence. The personality traits of the patients become more pronounced as a result of the illness. The continuous development of the patients corresponds to the personality traits. Changes in personality, in particular those caused by organic brain disease were not found. Because we applied strict criteria to the selection of our patients we conclude that the uniform psychopathological symptoms and the uniform personality traits of the patients are an essential element of the clinical picture of active acromegaly.

Acromegaly↗
PubMed1986

Neurosurgical experience with magnetic resonance imaging in sellar lesions.

41 patients with various sellar and parasellar lesions (pituitary adenomas, meningiomas, optic gliomas, craniopharyngeomas and granulomas), who underwent surgery consecutively, were studied by MRI investigations. In 10 patients post-operative MRI controls were performed. The information obtained by the MRI were compared with the other radiological investigations (especially coronar and axial high resolution CT), and the intra-operative findings. The advantages of MRI in the diagnosis of sellar lesion are demonstrated by exemplary cases.

Adolescent↗
PubMed1986

[Nuclear magnetic resonance tomography of the orbits. Initial experiences using the paramagnetic contrast medium gadolinium-DTPA].

In 21 patients with orbital mass lesions MRI was performed before and after administration of paramagnetic contrast medium, Gadolinium-DTPA. In comparison to the plain scan the differentiation of the tumorous tissue against the surrounding structures was improved after application of contrast medium despite a partially moderate increase in signal intensity. Especially highly vascular tumors and vessel diseases show a significant contrast enhancement. With increasing experience in larger number of patients a tissue differentiation seems to be possible.

Adult↗
PubMed1985

Recurrent pituitary adenomas.

Based on 880 pituitary adenomas operated upon between 1972 and 1982 the diagnostic and therapeutical strategy in recurrences is discussed. The incidence of reoperations was 7.75%, 3.7% in hormonally inactive and 4.1% in hormonally active recurrences. The rate was 30% after transcranial surgery--due to the extension of the tumours--and 5% after the trans-sphenoidal approach. In hormone inactive adenomas visual impairment in 29 out of 50 recurrences caused a second operation combined with radiotherapy in 13 cases. Radiotherapy alone was used in 17 cases. In hormonally active adenomas the treatment of persistent hormonal excess represents the main therapeutical problem. With HGH-producing adenomas a return to normal was achieved in 22 cases mainly by a combination of reoperation and radiotherapy (12) or radiotherapy (8) alone. Radiotherapy should be avoided in young patients whenever possible. The procedure of choice in PRL-producing adenomas (14 cases) seems to be treatment with dopamine-agonists (9). An additional reoperation was necessary in five cases.

Adenoma↗
PubMed1985

[Value of nuclear magnetic resonance tomography in the diagnosis and therapy outcome of prolactinomas].

30 MR tomographies were performed in 15 patients suspected of having a prolactinoma on account of clinical examinations and test in the chemical laboratory. The T1 and T2 times of the adenomas were determined quantitatively. In addition, high resolution CT imaging had been performed in all patients. The signal performance of the normal pituitary gland determined in 11 healthy persons on the basis of quantitatively measured T1 and T2 times, was found to largely correspond with that of grey matter of the brain. Of the 14 confirmed prolactinomas, 11 were microadenomas and 3 macroadenoma. Solid adenomas were identified by enhanced T1 values. It was possible to differentiate these from cystic, haemorrhagic and necrotic tumour components by differences in signal performance. 7 patients on drug therapy with dopamine agonists were controlled by means of MR tomography. No measurable size reduction of tumour was seen in 3 patients with cystic or haemorrhagic tumour components. On the other hand, tumour reduction was seen after brief drug therapy in 2 macroprolactinomas and one microprolactinoma. An essential advantage offered by MR is, besides the absence of exposure to radiation, in the first place the better and more precise information on the relative position of the adenoma with reference to the vessels and the optic chiasm, and, secondly, better identification of cystic and haemorrhagic processes within the prolactinoma.

Adenoma↗
PubMed1981

[Early diagnosis and treatment of aneurysmal hemorrhages (author's transl)].

The diagnostic and therapeutic procedures after aneurysmal hemorrhage are described. The most important aspects in history-taking, indication for lumbar puncture, the evaluation of computer tomographic findings and the method of angiography are presented and in particular the timely coordination of the preoperative measures and the operation is commented on.

Cerebral Angiography↗