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At least 613 records · Page 34Linked to original sources
PubMed1978

Chemical hypophysectomy for relief of bone pain in carcinoma of the prostate.

A series is presented of 10 patients with intractable pain secondary to diffuse metastatic prostatic carcinoma. These patients underwent pituitary ablation by a new method of chemical hypophysectomy, which consisted of multiple injections of absolute alcohol into the pituitary gland under stereotaxic control. Of the 10 patients 9 had good to excellent pain relief. There was no operative mortality. The sequelae are those associated with pituitary destruction, the most significant being diabetes insipidus. Preoperative and postoperative hormonal studies failed to reveal any significant hormonal changes despite good and almost immediate pain relief.

Diabetes Insipidus↗
PubMed1984

Shock-induced analgesia on the formalin test: effects of shock severity, naloxone, hypophysectomy, and associative variables.

Rats were exposed to three shocks, spaced 20 s apart, at two different levels of severity, low (.75 s, 1 mA) and high (3 s, 4 mA). Both shock levels produced a similar suppression of the recuperative behavior elicited by an injection of formalin into a rat's hind paw. Naloxone fully reversed the analgesia produced by the low-severity shock but only partially reversed the analgesia produced by the high-severity shock (Experiment 1). Hypophysectomy did not alter the level of analgesia (Experiment 2). When the rats were tested in a chamber different from the one they were shocked in, both analgesias were totally reversed (Experiment 3). However, imposing a delay between shock and analgesia testing did not reduce analgesia (Experiment 4). These results suggest that analgesia is not directly elicited by the shock but by apparatus stimuli associated with shock. Further support for this position was obtained when it was found that a Pavlovian extinction procedure could completely eliminate analgesia (Experiment 5). In all of the experiments, the freezing response, one of the rat's species-specific defense reactions, was monitored simultaneously with recuperative behavior. A parallel was found between analgesia and this defensive response, a result suggesting that an animal's endogenous analgesic systems may be activated along with the animal's defensive motivational system. The results point to the critical nature of associative variables in the control of endogenous analgesic systems. They also suggest that shock severity is a determinant of analgesia's sensitivity to naloxone.

Animals↗
PubMed1996

Desflurane and isoflurane increase lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy.

BACKGROUND: Rapid emergence from anesthesia makes desflurane an attractive choice as an anesthetic for patients having neurosurgery. However, the data on the effect of desflurane on intracranial pressure in humans are still limited and inconclusive. The authors hypothesized that isoflurane and desflurane increase intracranial pressure compared with propofol. METHODS: Anesthesia was induced with intravenous fentanyl and propofol in 30 patients having transsphenoidal hypophysectomy with no evidence of mass effect, and it was maintained with 70% nitrous oxide in oxygen and a continuous 100 micrograms.kg-2.min-1 infusion of propofol. Patients were assigned to three groups randomized to receive only continued propofol infusion (n = 10), desflurane (n = 10), or isoflurane (n = 10) for 20 min. During the 20-min study period, each patient in the desflurane and isoflurane groups received, in random order, two concentrations (0.5 minimum alveolar concentration [MAC] and 1.0 MAC end-tidal) of desflurane or isoflurane for 10 min each. Lumbar cerebrospinal fluid (CSF) pressure, blood pressure, heart rate, and anesthetic concentrations were monitored continuously. RESULTS: Lumbar CSF pressure increased significantly in all patients receiving desflurane or isoflurane. Lumbar CSF pressure increased by 5 +/- 3 mmHg at 1-MAC concentrations of desflurane and by 4 +/- 2 mmHg at 1-MAC concentrations of isoflurane. Cerebral perfusion pressure decreased by 12 +/- 10 mmHg at 1-MAC concentrations of desflurane and by 15 +/- 10 mmHg at 1-MAC concentrations of isoflurane. Heart rate increased by 7 +/- 9 bpm with 0.5 MAC desflurane and by 8 +/- 7 bpm with 1.0 MAC desflurane, and by 5 +/- 11 bpm with 1.0 MAC isoflurane. Systolic blood pressure decreased in all but the patients receiving 1.0 MAC desflurane. To maintain blood pressure within predetermined limits, phenylephrine was administered to six of ten patients in the isoflurane group (range, 25 to 600 micrograms), two of ten patients in the desflurane group (range, 200 to 500 micrograms), and in no patients in the propofol group. Lumbar CSF pressure, heart rate, and systolic blood pressure did not change in the propofol group. CONCLUSION: Desflurane and isoflurane, at 0.5 and 1.0 MAC, increase lumbar CSF pressure.

Adult↗
PubMed1980

Treatment of pain of diffuse metastatic cancer by stereotactic chemical hypophysectomy: long term results and observations on mechanism of action.

Stereotactic instillation of absolute alcohol into the sella turcica for pituitary destruction was carried out in 29 patients divided into two groups. Seventeen with prostatic carcinoma underwent a total of 19 injections with 94% good to excellent results that persisted throughout the remainder of the patient's life-span. The longest survival was 9 months. Brief relapses did occur, but spontaneous remissions were the rule. A second group of mixed cancers contained 12 patients who received a total of 13 injections. Eleven patients had good to excellent results that persisted in all but 1 patient. The longest survival was 7 months. Hormonal levels and prolactin stimulation tests failed to show any correlation between hormonal changes and pain relief. Naloxone reversal of analgesia did not occur. There was no loss of cognitive function shown on psychological testing. Pathological studies showed destruction of the pituitary gland, which was subtotal in some patients despite good pain relief. All examinations showed that the pituitary stalk was destroyed. Patients who survived longer also showed degeneration of the supraoptic and paraventricular nuclei of the hypothalamus and the median eminence. All but 1 patient with pain relief exhibited a lack of antidiuretic hormone (ADH) production. Interpretation of the data indicates that ADH or its associated neurophysins act as central pain transmitters. The production of these transmitters is decreased or abolished by chemical hypophysectomy through the destruction of hypothalamic nuclei.

Cognition↗