Science.gov

Sample records for sellae tuberculum sellae

  1. Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas.

    PubMed

    Ditzel Filho, Leo F S; Prevedello, Daniel M; Jamshidi, Ali O; Dolci, Ricardo L; Kerr, Edward E; Campbell, Raewyn; Otto, Bradley A; Carrau, Ricardo L; Kassam, Amin

    2015-07-01

    Tuberculum sellae meningiomas are challenging lesions; their critical location and often insidious growth rate enables significant distortion of the superjacent optic apparatus before the patient notices any visual impairment. This article describes the technical nuances, selection criteria and complication avoidance strategies for the endonasal resection of tuberculum sellae meningiomas. A stepwise description of the surgical technique is presented; indications, adjuvant technologies, pitfalls and the relevant anatomy are also reviewed. Tuberculum sellae meningiomas may be safely and effectively resected through the endonasal route; invasion of the optic canals does not represent a limitation. PMID:26141355

  2. [ENDOSCOPIC REMOVAL OF TUBERCULUM SELLAE MENINGEOMA THROUGH ENDONASAL TRANSSPHENOIDAL APPROACH].

    PubMed

    Fülöp, Béla; Bella, Zsolt; Palágyi, Péter; Barzó, Pál

    2016-03-30

    Experiences acquired in our department with endoscope assisted microsurgical transsphenoidal pituitary surgery encouraged us to expanded the endoscopic approach to skull base lesions. The endoscopic endonasal transsphenoidal approach proved to be less traumatic to the traditional microsurgical approaches, yet very effective. The endoscopic transsphenoidal technique was applied in a patient havin anterior skull base tumor. The patient was a 49-year-old woman with several months history of left visual defect. The magnetic resonance (MR) scans of the skull revealed a midline anterior fossa space-occupying lesion measuring 21 x 16 x 22 mm located on planum sphenoidale, tuberculum sellae and intrasellar. The tumor compressed both optic nerves and optic chiasm. Total resection of the tumor was achieved by use of endoscopic transnasal, transsphenoidal technique. This is the first reported case of an anterior fossa meningeoma being treated by an endoscopic transsphenoidal technique in Hungary. PMID:27188006

  3. Optic Nerve Vascular Compression in a Patient with a Tuberculum Sellae Meningioma

    PubMed Central

    Mizrahi, Cezar José; Moscovici, Samuel; Dotan, Shlomo; Spektor, Sergey

    2015-01-01

    Background. Optic nerve vascular compression in patients with suprasellar tumor is a known entity but is rarely described in the literature. Case Description. We present a unique, well-documented case of optic nerve strangulation by the A1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. The patient presented with pronounced progressive visual deterioration. Following surgery, there was immediate resolution of her visual deficit. Conclusion. Vascular strangulation of the optic nerve should be considered when facing progressive and/or severe visual field deterioration in patients with tumors proximal to the optic apparatus. PMID:25705535

  4. Optic nerve vascular compression in a patient with a tuberculum sellae meningioma.

    PubMed

    Mizrahi, Cezar José; Moscovici, Samuel; Dotan, Shlomo; Spektor, Sergey

    2015-01-01

    Background. Optic nerve vascular compression in patients with suprasellar tumor is a known entity but is rarely described in the literature. Case Description. We present a unique, well-documented case of optic nerve strangulation by the A1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. The patient presented with pronounced progressive visual deterioration. Following surgery, there was immediate resolution of her visual deficit. Conclusion. Vascular strangulation of the optic nerve should be considered when facing progressive and/or severe visual field deterioration in patients with tumors proximal to the optic apparatus. PMID:25705535

  5. Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas.

    PubMed

    Khan, Osaama H; Krischek, Boris; Holliman, Damian; Klironomos, George; Kucharczyk, Walter; Vescan, Allan; Gentili, Fred; Zadeh, Gelareh

    2014-06-01

    The expanded endoscopic endonasal (EEE) approach for the removal of olfactory groove (OGM) and tuberculum sellae (TSM) meningiomas is currently becoming an acceptable surgical approach in neurosurgical practice, although it is still controversial with respect to its outcomes, indications and limitations. Here we provide a review of the available literature reporting results with use of the EEE approach for these lesions together with our experience with the use of the endoscope as the sole means of visualization in a series of patients with no prior surgical biopsy or resection. Surgical cases between May 2006 and January 2013 were retrospectively reviewed. Twenty-three patients (OGM n=6; TSM n=17) were identified. In our series gross total resection (GTR) was achieved in 4/6 OGM (66.7%) and 11/17 (64.7%) TSM patients. Vision improved in the OGM group (2/2) and 8/11 improved in the TSM group with no change in visual status in the remaining three patients. Post-operative cerebrospinal fluid (CSF) leak occurred in 2/6 (33%) OGM and 2/17 (11.8%) TSM patients. The literature review revealed a total of 19 OGM and 174 TSM cases which were reviewed. GTR rate was 73% for OGM and 56.3% for TSM. Post-operative CSF leak was 30% for OGM and 14% for TSM. With careful patient selection and a clear understanding of its limitations, the EEE technique is both feasible and safe. However, longer follow-ups are necessary to better define the appropriate indications and ideal patient population that will benefit from the use of these newer techniques. PMID:24433951

  6. Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography.

    PubMed

    Liao, Chih-Hsiang; Lin, Chung-Jung; Lin, Chun-Fu; Huang, Hsin-Yi; Chen, Min-Hsiung; Hsu, Sanford P C; Shih, Yang-Hsin

    2016-08-01

    OBJECTIVE The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA). METHODS Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks. RESULTS Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow

  7. The Enigma behind Pituitary and Sella Turcica

    PubMed Central

    Gopalakrishnan, Umarevathi; Mahendra, Lodd; Rangarajan, Sumanth; Madasamy, Ramasamy; Ibrahim, Mohammad

    2015-01-01

    The pituitary gland's role as a functional matrix for sella turcica has not been suggested in orthodontic literature. This paper is an attempt to correlate the role of pituitary gland in the development of sella turcica. A case report of dwarfism associated with hypopituitarism is presented to highlight the above hypothesis. PMID:26199763

  8. A Cephalometric Analysis on Magnitudes and Shape of Sella Turcica.

    PubMed

    Rai, Ashwin R; Rai, Rohan; Pc, Vani; Rai, Rajalakshmi; Vadgaonkar, Rajanigandha; Tonse, Mamatha

    2016-07-01

    Familiarity with the shape and dimensions of sella turcica is important to recognize and manage pathological conditions of pituitary gland as well as for orthodontic treatment planning. The present study aims to describe the morphology and dimensions of sella turcica from Indian population, using lateral cephalograms to set a reference data for comparison among different races. The study used 36 lateral skull radiographs of both sexes between age group of 13 to 18 years. Shape of sella turcica was noted by visual inspection. Length, height anterior, height median, height posterior, distance between frontonasal suture and mental spine to midpoint of posterior clinoid process, and tuberculum sella were measured using digital vernier caliper with reference to Frankfort line. The results of the study revealed that mean length, height anterior, height median, height posterior were larger in females than in males. The morphological types identified include pointed posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with flask-shaped hypophyseal fossa. These observations would be beneficial for the clinicians and orthodontists to design treatment planning in pathology of pituitary gland and in correcting dentofacial anomalies. PMID:27380565

  9. Sella size and jaw bases - Is there a correlation???

    PubMed Central

    Neha; Mogra, Subraya; Shetty, Vorvady Surendra; Shetty, Siddarth

    2016-01-01

    Introduction: Sella turcica is an important cephalometric structure and attempts have been made in the past to correlate its dimensions to the malocclusion. However, no study has so far compared the size of sella to the jaw bases that determine the type of malocclusion. The present study was undertaken to find out any such correlation if it exists. Materials and Methods: Lateral cephalograms of 110 adults consisting of 40 Class I, 40 Class II, and 30 Class III patients were assessed for the measurement of sella length, width, height, and area. The maxillary length, mandibular ramus height, and body length were also measured. The sella dimensions were compared among three malocclusion types by one-way ANOVA. Pearson correlation was calculated between the jaw size and sella dimensions. Furthermore, the ratio of jaw base lengths and sella area were calculated. Results and Conclusion: Mean sella length, width and area were found to be greatest in Class III, followed by Class I and least in Class II though the results were not statistically significant. 3 out of 4 measured dimensions of sella, correlated significantly with mandibular ramus and body length each. However, only one dimension of sella showed significant correlation with maxilla. The mandibular ramus and body length show a nearly constant ratio to sella area (0.83–0.85, 0.64–0.65, respectively) in all the three malocclusions. Thus, mandible has a definite and better correlation to the size of sella turcica. PMID:27041903

  10. The incidence and types of sella and sphenopetrous bridges.

    PubMed

    Peker, T; Anil, A; Gülekon, N; Turgut, H B; Pelin, C; Karaköse, M

    2006-07-01

    The incidence and types of sella and sphenopetrous bridges were investigated in 37 adult male and 43 adult female (a total of 80) dry skulls with removed calvarias. In addition to this, the sellar and parasellar region of ten fixed cadavers (two female and eight male) were carefully dissected, and the individuals were examined for the evidence of sella and sphenopetrous bridges. Sella bridges were seen in 34.17% of the subjects overall. The trace, incomplete and complete types were 11.9%, 3.7% and 17.5%, respectively. On the other hand, sphenopetrous bridges were observed in 15.8% of the male and 4.9% of the female subjects overall. The cadaveric investigation revealed one trace, three incomplete, and one complete sella bridge in three cadavers. In addition to this, a complete sphenopetrous bridge was detected in one of the cadavers. Variations in the cranial base are of importance for surgical approaches in that location. PMID:16528575

  11. Primary empty sella syndrome with panhypopituitarism in a child.

    PubMed

    Dawod, S T; Isseh, N M; Kalantar, S M; Jorulf, H K; Ajlouni, K M

    1984-12-01

    A 10-year-old boy presented with marked growth retardation. He was found to have an empty sella demonstrated by CT and Metrizamide cisternography. Endocrinological investigation confirmed the diagnosis of panhypopituitarism. This is the first case reported in a twin and the fifth pediatric case with marked endocrine dysfunction reported in the literature. PMID:6543857

  12. [A case of solitary fibrous tumor in the sella turcica].

    PubMed

    Shimizu, Kiyoharu; Tominaga, Atsushi; Kinoshita, Yasuyuki; Usui, Satoshi; Sugiyama, Kazuhiko; Kurisu, Kaoru

    2013-10-01

    A 64-year-old male presented with an incidental tumor in the sella turcica during a brain medical checkup. Because he lacked any neurological symptoms or signs of pituitary dysfunction, the patient did not undergo surgery. Three years later, visual disturbances developed, including poor eyesight and visual field defects. The response to the growth hormone(GH)releasing peptide-2 demonstrated severe GH deficiency. MRI revealed an enlarged tumor appearing as a mosaic pattern of high and very low intensity on T2-weighted imaging. The region of very low intensity on T2-weighted imaging exhibited enhancement after T1 gadolinium-DTPA administration. The tumor was totally removed via the microscopic trans-sphenoidal approach in combination with endoscopic observation. The hard tumor adhered to the dura of the sella turcica and the medial wall of the left cavernous sinus. Histological verification confirmed a solitary fibrous tumor(SFT). Fourteen months after the operation, MRI revealed no recurrent tumors. SFT infrequently occurs in the sella turcica; however it should be included in the differential diagnosis in cases of enhanced tumors with marked low intensity on T2-weighted imaging. PMID:24091460

  13. Anthropometric Parameters for Access to Sella Turcica Through the Nostril.

    PubMed

    Mohamadi, Yousef; Mousavi, Mahboubeh; Pakzad, Reza; Hassanzadeh, Gholamreza

    2016-09-01

    The pituitary gland is located in the sella turcica. Pituitary tumors constitute approximately 15% of intracranial benign tumors. "Endo nasal endoscopic trans-sphenoidal" method is an appropriate surgical technique to remove this tumor. In this operation an endoscope enters the nasal cavity through the nostril to reach the floor of the sella turcica. The aim of this study was an anthropometric evaluation of the route of endoscope in this surgery. Two hundred twenty-seven patients (116 women, 111 men) were divided into ≥30, 31 to 61, and ≥61-year age groups. Lateral scanograms of skull were used to measure 3 linear distances and 1 angle. While the mean of the linear variables was significantly higher in men (P <0.001), this difference was not significant in angular measurement between sexes. More detail evaluation of the age groups showed age- and sex-specific differences in measurements. The authors concluded that it needs to consider the anthropometrical indexes in pituitary surgery. PMID:27526241

  14. [Treatment of primary empty sella with intractable headache via the transsphenoidal approach].

    PubMed

    Hashimoto, N; Okamoto, S; Yamagami, T; Kojima, M; Nakahara, I; Handa, H

    1985-07-01

    Two cases of primary empty sella with intractable headache were treated via the transsphenoidal approach. One patient was a fifty-three-year-old female with right upper nasal quadrantanopsia and intractable retrobulbar pain and the other was fourty-six-year-old female with continuous retrobulbar pain with a history of transient right temporal hemianopsia. Both cases were diagnosed by metrizamide CT cisternography. They had normal endocrinological functions. They did not respond to drug therapy and were treated surgically. In each case, the dura mater of the floor of the sella was elevated with lyophilized human dura mater and bone fragments obtained during the procedure. In the former case, significant improvement of visual field defect was not obtained but the retrobulbar pain disappeared completely after the operation. In the latter case which had intractable headache for six months, the symptom disappeared just after the operation. Until now, retroorbital pain has not recurred in both cases for several months. Primary empty sella has been considered to be a benign condition except in some cases with CSF rhinorrhea or with visual disturbance. Headache which is often accompanied to primary empty sella has rarely been treated surgically because it is difficult to know whether the headache is related to the empty sella or not. Another reason may be that there is few available data concerning to the efficacy of surgical treatment. Headache caused by stretching of the dura of the floor of the sella is usually frontal or retrobulbar, continuous, profound and intractable.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4047326

  15. From Pituitary Expansion to Empty Sella: Disease Progression in a Mouse Model of Autoimmune Hypophysitis

    PubMed Central

    Lupi, Isabella; Zhang, Jiangyang; Gutenberg, Angelika; Landek-Salgado, Melissa; Tzou, Shey-Cherng; Mori, Susumu

    2011-01-01

    Lymphocytic hypophysitis has a variable clinical course, where a swelling of the pituitary gland at presentation is thought to be followed by pituitary atrophy and empty sella. Data in patients, however, are scanty and contradictory. To better define the course of hypophysitis, we used an experimental model based on the injection of pituitary proteins into SJL mice. A cohort of 33 mice was divided into three groups: 18 cases were immunized with pituitary proteins emulsified in complete Freund's adjuvant; six controls were injected with adjuvant only; and nine controls were left untreated. Mice were followed by cranial magnetic resonance imaging (MRI) for up to 300 d, for a total of 106 MRI scans, and killed at different time points to correlate radiological and pathological findings. Empty sella was defined as a reduction in pituitary volume greater than 2 sd below the mean volume. All immunized mice showed by MRI a significant expansion of pituitary volume during the early phases of the disease. The volume then decreased gradually in the majority of cases (14 of 18, 78%), reaching empty sella values by d 300 after immunization. In a minority of cases (four of 18, 22%), the decrease was so rapid and marked to induce a central area of necrosis accompanied by hemorrhages, mimicking the condition known in patients as pituitary apoplexy. No radiological or pathological changes were observed in controls. Overall, these findings indicate that the evolution of hypophysitis is complex but can lead, through different routes, to the development of empty sella. PMID:21862619

  16. Sphenoid sinus barotrauma with intracranial air in sella turcica after diving.

    PubMed

    Tryggvason, G; Briem, B; Guomundsson, O; Einarsdóttir, H

    2006-10-01

    We report the case of a diver who presented with air in the sella turcica after barotrauma to the sphenoid sinus during an ascent from a dive. To our knowledge, this is the first report of intracranial air after a barotrauma to the sphenoid sinus. PMID:17050370

  17. Extra-Pontine Myelinolysis in a Case of Pan-hypopituitarism Due to Empty Sella Syndrome.

    PubMed

    Gupta, Vishal Anand; Karnik, Niteen; Itolikar, Manish; Vekariya, Ketan

    2015-10-01

    Rapid correction of hyponatremia is known to cause central pontine myelinolysis (CPM). It may concurrently involve other areas of brain as well, referred as extra-pontine myelinolysis (EPM). Isolated EPM however is a very rare occurrence. We present a case of EPM where the hyponatremia was secondary to hypothyroidism due to empty sella syndrome. Chronic hyponatremia should always be corrected slowly to avoid such osmotic myelinolysis syndromes (OMS). PMID:27608705

  18. Characterization and optimization of conditions for biodegradation of sella-rice mill effluent.

    PubMed

    Malik, Kamla; Garg, Faquir Chand; Nehra, Kiran

    2011-11-01

    The sella-rice mill effluent is a major environmental pollutant requiring proper treatment before disposal. The present study has been conducted to isolate and characterize micro-organisms capable of growing on sella-rice effluent and to optimize conditions for its rapid bioremediation. Using three different types of media (LB, YEPDA and PDA), a total of 139 isolates were isolated from effluent samples collected from three different locations. Out of these, 45 isolates were found to utilize starch on starch medium, eight isolates showing high efficiency. For the optimization of conditions for maximum utilization of starch by selected isolates, parameters such as effect of addition of carbon and nitrogen sources, effect of growth factors, temperature and pH were studied. Maximum growth (absorbance of 2.10) and starch-utilization (varying in the range of 2.33 to 3.62) was observed on starch medium supplemented with peptone and yeast extract at 30 degrees C with a pH of 6.0. These bacterial isolates also reduced the amount of starch (80.10%), BOD (64.24%) and COD (75.0%) of sella-rice mill effluent after 15 days of incubation. On the basis of morphological and biochemical characteristics, the selected isolates were found to belong to the genera Lactobacillus and Micrococcus. PMID:22471214

  19. Psychosis in Secondary Empty Sella Syndrome following a Russell's Viper Bite

    PubMed Central

    Ratnakaran, Badr; Punnoose, Varghese P.; Das, Soumitra; Kartha, Arjun

    2016-01-01

    Hypopituitarism can present with psychiatric symptoms. We report a unique case of psychosis in clear consciousness in a case of hypopituitarism due to the secondary empty sella syndrome following a Russell's viper bite which was untreated and presented with psychotic symptoms for past 13 years following the snake bite. After the diagnosis of psychosis due to hypopituitarism was made, the patient was treated with levothyroxine and prednisolone supplements and his psychotic symptoms subsided without any psychotropic drugs. Vasculotoxic snake bites can cause hypopituitarism and can present with psychosis. Further research will be needed into the prevalence of this phenomenon. PMID:27335524

  20. A Case Report of Late Onset Mania Caused by Hyponatremia in a Patient With Empty Sella Syndrome

    PubMed Central

    Yang, Chung-Hao; Lin, Yu-Chen; Chou, Po-Han; Chen, Hung-Chieh; Chan, Chin-Hong

    2016-01-01

    Abstract Recurrent manic-like episodes can be induced by hyponatremia possibly due to empty sella syndrome. In the present case, the patient was proven to have syndrome of inappropriate antidiuretic hormone (SIADH) secretion with manic symptoms that resolved after the normalization of the plasma sodium level. To our knowledge, this is the first case of hyponatremia-induced manic symptoms in a patient with empty sella syndrome. More attention should be paid to late-onset mania, because it may be the sign of a more serious medical problem. PMID:26871784

  1. 78 FR 13870 - Roberto Sella; Notice of Declaration of Intention and Soliciting Comments, Protests, and/or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-01

    ...: Hydro-electric and Geothermal Alternative Energy System at Paper Hill Farm (Paper Hill Farm). f... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Roberto Sella; Notice of Declaration of Intention and Soliciting...

  2. Diabetes Insipidus and Polydipsia in a Patient with Asperger's Disorder and an Empty Sella: A Case Report.

    ERIC Educational Resources Information Center

    Raja, Michele; Azzoni, Antonella; Giammarco, Vincenzo

    1998-01-01

    Describes an Italian patient with Asperger disorders, Neurogenic Diabetes Insipidus, and Primary Empty Sella. His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. Implications of the observed concurrence of these rare disorders are discussed in relation to diagnosis and pathogenesis. (Author/CR)

  3. Symptomatic empty sella syndrome: an unusual manifestation of Erdheim–Chester disease

    PubMed Central

    Loh, Wann Jia; Sittampalam, Kesavan; Tan, Suan Cheng

    2015-01-01

    Summary Erdheim–Chester disease (ECD) is a potentially fatal condition characterized by infiltration of multiple organs by non-Langerhans histiocytes. Although endocrine dysfunction has been reported in association with ECD, to date, there have been no previous reports of empty sella syndrome (ESS) associated with it. We report the case of a patient with ECD who had symptomatic ESS. A 55-year-old man of Chinese ethnicity initially presented with symptoms of heart failure, fatigue and knee joint pain. Physical examination revealed xanthelasma, gynaecomastia, lung crepitations, hepatomegaly and diminished testicular volumes. He had laboratory evidence of hypogonadotrophic hypogonadism, secondary hypoadrenalism and GH deficiency. Imaging studies showed diffuse osteosclerosis of the long bones on X-ray, a mass in the right atrium and thickening of the pleura and of the thoracic aorta on fusion positron emission tomography–computed tomography. Magnetic resonance imaging (MRI) of the brain showed an empty sella. The diagnosis of ECD was confirmed by bone biopsy. Learning points ECD is a multisystemic disease that can affect the pituitary and other organs. The diagnosis of ECD is based on clinical and radiological features and histology, showing lipid-laden CD68+ CD1a− S100− histiocytes surrounded by fibrosis.The finding of xanthelasmas especially in the presence of normal lipid levels in the presence of a multisystem infiltrative disorder should raise the suspicion of ECD.Systemic perturbation of autoimmunity may play a role in the pathogenesis of ECD and is an area that merits further research. PMID:25810917

  4. Sporadically second localization of cerebellar hemangioblastoma in sella turcica mimicking a meningioma with no associated von Hippel-Lindau disease.

    PubMed

    Amelot, Aymeric; Bouazza, Schaharazad; Polivka, Marc; George, Bernard; Bresson, Damien

    2015-01-01

    A 72-year-old man presented with a gradual bilateral decrease in visual acuity. Imaging showed lesion in the sella turcica diagnosed as meningioma but proving secondarily to be a hemangioblastoma. His neurosurgical history included a resection of a cerebellar hemangioblastoma 30 years ago. To our knowledge, such a hemangioblastoma second localization from the infratentorial to supratentorial has not been reported in the literature for patients not presenting with von Hippel-Lindau disease. PMID:25817084

  5. [Diagnosis and treatment of patients with primary "empty" sella turcica syndrome at the stage of sanatorium-and-spa rehabilitation].

    PubMed

    Efimenko, N V; Akhkubekova, N K; Babiakin, A F; Kaĭsinova, A S

    2010-01-01

    The authors report the first attempt to develop the treatment strategy for patients with primary "empty" sella turcica syndrome based at a health resort facility. It is shown that combined therapy including radon baths and acupuncture at specific auricular points makes it possible to improve functioning of the pituitary-ovarian system, decrease body weight, normalize blood prolactin level, eliminate visceral obesity, enhance tissue sensitivity to insulin, reduce hyperinsulimenia and fertility problems (anovulation, hyperandrogenism, and hypoluteinism) associated with insulin resistance. PMID:21086599

  6. Sella Turcica Atypical Teratoid/Rhabdoid Tumor Complicated with Lung Metastasis in an Adult Female

    PubMed Central

    Moretti, Costanzo; Lupoi, Domenico; Spasaro, Francesca; Chioma, Laura; Di Giacinto, Paola; Colicchia, Martina; Frajoli, Mario; Mocini, Renzo; Ulisse, Salvatore; Antonelli, Manila; Giangaspero, Felice; Gnessi, Lucio

    2013-01-01

    Here we present the case of a 60-year-old woman with a rare sellar region atypical teratoid/rhabdoid tumor (AT/RT), complicated by lung metastasis and treated with neurosurgery, radiotherapy, and chemotherapy. The patient had recurrent headache associated with left cavernous sinus syndrome after a previous endonasal transsphenoidal resection for a presumptive pituitary macroadenoma. Pituitary magnetic resonance imaging showed a tumor regrowth in the original location with a haemorrhagic component involving the left cavernous sinus. A near complete transsphenoidal resection of the sellar mass was performed followed by 3 months of stereotactic radiotherapy. Because of a worsening of the general clinical conditions, respiratory failure, and asthenia, the patient underwent a contrast enhanced computer tomography of the whole body which showed the presence of lung metastasis. The histopathological diagnosis on samples from pituitary and lung tissues was AT/RT. The patient survived 30 months after diagnosis regardless chemotherapy. In the adult, the AT/RT should be considered as a possible rare, aggressive, and malignant neoplasm localized in the sella turcica. PMID:24324353

  7. Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region

    PubMed Central

    Louis, Robert G.; Eisenberg, Amy; Barkhoudarian, Garni; Griffiths, Chester; Kelly, Daniel F.

    2014-01-01

    Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology. Objectives This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances. Data Synthesis The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations. Conclusions Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, further work remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are complementary

  8. Visual Deterioration and Herniation of the Anterior Cerebral Artery: Unusual Presentation of an Empty Sella Syndrome Complicating Decompression of a Rathke Cleft Cyst.

    PubMed

    Sivaraju, Laxminadh; Thakar, Sumit; Hegde, Alangar S

    2016-06-01

    Clinical manifestations of empty sella syndrome include hypopituitarism cerebrospinal fluid rhinorrhea, headache, and visual abnormalities. A 21-year-old woman reported a 6-month history of worsening vision 3 years after decompression of a sellar-suprasellar Rathke cleft cyst. Her magnetic resonance imaging (MRI) showed a well-defined recurrent cyst in the sellar-suprasellar region causing chiasmatic compression. She underwent an endonasal, endoscopic decompression of the cyst, with subsequent improvement in her vision. A postoperative computed tomography confirmed good decompression of the cyst. Ten days after surgery, she reported sudden loss of vision in both eyes. MRI revealed an empty sella with herniation of both anterior cerebral arteries and optic chiasm into the sella. She underwent transnasal packing of the sellar floor with fat graft and bone plaques, and experienced gradual improvement in vision in her right eye. PMID:26828843

  9. Ectopic Acromegaly Arising from a Pituitary Adenoma within the Bony Intersphenoid Septum of a Patient with Empty Sella Syndrome

    PubMed Central

    Arzamendi, Audrey E.; Shahlaie, Kiarash; Latchaw, Richard E.; Lechpammer, Mirna; Arzumanyan, Hasmik

    2016-01-01

    Objective  To describe the work-up and treatment of rare ectopic acromegaly caused by a biopsy-proven somatotroph pituitary adenoma located within the bony intersphenoid septum of a patient with empty sella syndrome (ESS). Methods  We report the presentation, clinical course, diagnostic work-up, and lesion localization and treatment challenges encountered in a 55-year-old patient, with a brief review of relevant literature. Results  A 55-year-old African-American man presented with acromegaly and ESS. Attempts to definitively localize the causative tumor were unsuccessful, though petrosal sinus sampling supported central growth hormone production and imaging suggested bone-enclosed subsellar pituitary tissue. Endoscopic endonasal transphenoidal exploration was undertaken with resection of a somatotroph pituitary microadenoma, and subsequent clinical improvement and biochemical remission. Retrospective review revealed the patient's pituitary to have been located ectopically within a unique bony intersphenoid septum. Conclusion  This report describes the first known case of an ectopic pituitary adenoma located within the midline bony intersphenoid septum, which we postulate to have resulted from anomalous embryological pituitary migration. Intra-intersphenoid septal tumors should be considered in cases of apparent central acromegaly with ESS or absence of tumor tissue within the paranasal sinuses or other peripheral locations. Indexing  Acromegaly, ESS, pituitary adenoma, sphenoid sinus septum. PMID:27468406

  10. Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report.

    PubMed

    Alvarez Berastegui, G Rene; Raza, Shaan M; Anand, Vijay K; Schwartz, Theodore H

    2016-04-01

    Visual deterioration after dopamine-agonist treatment of prolactinomas associated with empty sella syndrome and secondary optic apparatus traction is a rare event. Chiasmapexy has been described as a viable treatment option, although few cases exist in the literature. Here, a novel endonasal endoscopic approach to chiasmapexy is described and its efficacy is demonstrated in a case report. A 55-year-old female patient with a history of a giant prolactinoma and 14 years of treatment using dopaminergic agonist therapy presented to our institution with a 1-month history of visual changes. Neuroophthalmological examination confirmed severe bitemporal field defects, and MRI revealed a large empty sella with downward optic chiasmal herniation. Endoscopic endonasal chiasmapexy was performed by elevating the chiasm with lumbar drainage and filling the clival and sellar defect with an extradural liquid (HydroSet; a cranioplasty bone cement), and a piece of AlloDerm was used to cover and cushion the chiasm. Postoperative imaging demonstrated successful anatomical elevation of the optic apparatus, and the patient showed functional improvement in the visual field at 3 months postoperatively. Although rare, massive empty sellar and chiasmal descent from macroadenoma treatment can result in progressive visual loss. Here, a novel technique of endonasal endoscopic extradural cranioplasty aided by lumbar drainage is reported, which appears to be an effective technique for stabilizing and possibly reversing anatomical and visual deterioration. PMID:26339851

  11. Empty sella syndrome

    MedlinePlus

    Kaiser U, Ho KKY. Pituitary physiology and diagnostic evaluation. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier ...

  12. Empty Sella Syndrome

    MedlinePlus

    ... hormone deficiency, pituitary tumors, or pituitary gland dysfunction. Magnetic resonance imaging (MRI) scans are useful in evaluating ESS and for identifying underlying disorders that may be the cause of high fluid pressure. Is there any treatment? Unless the syndrome ...

  13. Are T2-weighted images more useful than T1-weighted contrast-enhanced images in assessment of postoperative sella and parasellar region?

    PubMed Central

    Bladowska, Joanna; Biel, Anna; Zimny, Anna; Lubkowska, Katarzyna; Bednarek-Tupikowska, Grażyna; Sozański, Tomasz; Zaleska-Dorobisz, Urszula; Sąsiadek, Marek

    2011-01-01

    Summary Background The proper diagnosis and management of patients after surgery for pituitary tumors are of great importance in clinical practice. The purpose of this study was to investigate the magnetic resonance features of the postoperative sella with fast spin echo T2-weighted imaging and to evaluate the benefits of this sequence compared to the classically performed contrast-enhanced T1-weighted imaging at 1.5T unit. Material/Methods The study group consisted of 101 patients who underwent resection of pituitary tumors. There were 58 women (57.4%), aged 22 to 75 (mean age, 52.67 years) and 43 men (42.6%), aged 21 to 79 (mean age, 49 years). In all patients preoperative and multiple postoperative MR studies were performed. Post-contrast T1 and pre-contrast T2 images were interpreted by 2 independent readers (neuroradiologists). Results Contrast-enhanced T1-weighted imaging was significantly superior to T2-weighted imaging in assessment of infundibulum (p<0.05). There was no statistically significant difference for each of readers between T1- and T2-weighted images regarding to the following features: visualization of residual pituitary gland (p=0.062 and p=0.368), contours of pituitary (p=0.959 and p=0.265), optic chiasm (p=0.294 and p=0.843), and visualization of presence of residual tumor (p=0.204 and p=0.169). T2-weighted images were significantly superior to contrast-enhanced T1-weighted imaging with regard to visualization of contours of residual tumors (p<0.05). Conclusions T2-weighted images may help to discriminate tumorous from non-tumorous involvement of the postoperative sella and the sphenoid sinus. T2-weighted images are also very useful for a long time after the resection in the postoperative evaluation of the implanted muscle with fascia. PMID:21959621

  14. Successful Surgical Treatment of Mature Teratoma Arising From the Sella

    PubMed Central

    Li, Yaxiong; Zhang, Yuekang; Xu, Jianguo; Chen, Ni

    2015-01-01

    Mature teratoma of the pituitary-hypothalamic region is rarely reported in the literature. In this article, we present a 13-year-old girl with clinical and radiological findings that were initially considered as germinoma. However, histological examinations disclosed a mature teratoma. This case highlights that the radiation-induced cerebral edema caused acute hydrocephalus. The mature teratoma is not radiosensitive, and the most appropriate treatment is direct surgery. PMID:25436031

  15. Ectopic suprasellar pituitary adenoma. A case report.

    PubMed

    Caranci, F; Cirillo, L; Bartiromo, F; Ferraioli, M; Del Basso De Caro, M L; Esposito, F; Cappabianca, P; Brunetti, A; Elefante, R

    2007-01-31

    The occurrence of a pituitary adenoma located entirely outside the sella turcica, so-called ectopic adenoma, is extremely rare. We report a case of a non secreting-pituitary adenoma located above the diaphragma sellae, with no invasion into the sella turcica, confirmed at surgery. The tumor was initially treated unsuccessfully by operations via the transphenoidal route. After initial negative exploration by the transphenoidal route, the patient was successfully treated by an endoscopic endonasal transphenoidal approach extended to the tuberculum sellae and the posterior planum sphenoidale to access the suprasellar supraglandular region. A brief review of ectopic adenomas and a discussion of the preoperative diagnosis are presented. PMID:24351300

  16. Fibrosing pseudotumor of the sella and parasellar area producing hypopituitarism and multiple cranial nerve palsies.

    PubMed

    Olmos, P R; Falko, J M; Rea, G L; Boesel, C P; Chakeres, D W; McGhee, D B

    1993-06-01

    We present an unusual patient with a medical history of a fibrosing pseudotumor of the left orbit that had been stable for 8 years who presented with acute anterior hypophyseal failure. During the next 10-month period, sequential magnetic resonance scans showed a rapid growth of a plaque-like sellar and parasellar mass extending into the right cavernous sinus, right Meckel's cave, along the dural surfaces of the clivus, dens, and body of the second cervical vertebra. A transsphenoidal biopsy revealed sphenoid and intrasellar pseudotumor that invaded the adenohypophysis and had microscopic features identical to those of the previously excised orbital pseudotumor. Rapid growth of the pseudotumor continued despite a course of radiotherapy. Palsies of cranial nerves V and VI and of the sensory root of the cranial nerve VII developed on the right side. Steroid therapy was associated with improvement of the cranial nerve palsies. This is the first report of the sellar fibrosing pseudotumor producing not only anterior hypophyseal failure, but also cranial nerve dysfunction secondary to plaque-like extension into the cavernous sinus, Meckel's cave, and cranial base dura. This intracranial plaque-like extension of a fibrous pseudotumor corresponds to a hypertrophic intracranial pachymeningitis, which is a rare, previously described phenomenon associated to the syndrome of multifocal fibrosclerosis. PMID:8327075

  17. Radiographic imaging of the distal dural ring for determining the intradural or extradural location of aneurysms.

    PubMed

    Beretta, Federica; Sepahi, Ali Nader; Zuccarello, Mario; Tomsick, Thomas A; Keller, Jeffrey T

    2005-11-01

    The effectiveness of several anatomical and radiological landmarks proposed to determine whether an aneurysm is located intradurally or extradurally is still debated. In anatomical and radiological studies, we examined the relationships of the distal dural ring (DDR) to the internal carotid artery (ICA) and surrounding bony structures to aid in the localization of aneurysms near the DDR. Anatomical relationships were examined by performing dissections on 10 specimens (5 formalin-fixed cadaveric heads). After the position of the DDR, optic nerve, and tuberculum sellae were marked with surgical steel wire, radiographs were taken in multiple projections. The only bony landmark consistently visible on radiographs was the planum sphenoidale. The superior border of the DDR is located at or below the level of the tuberculum sellae, which laterally becomes the superomedial aspect of the optic strut; thus, the optic strut marks the dorsal limit of the DDR. On 50 dry skulls, we measured the vertical distance between the planum sphenoidale and medial aspect of the optic strut (5.0 +/- 0.4 mm), the interoptic strut distance (14.4 +/- 1.4 mm), and the linear distance between the most posterior aspect of the planum sphenoidale (limbus sphenoidale) and the tuberculum sellae (6.0 +/- 0.5 mm). Using these measurements and the planum sphenoidale, tuberculum sellae, and optic strut as reference landmarks, we determined the location of the aneurysm relative to the DDR on angiographic images. In this way, we were able to identify whether lesions were intra- or extradural. PMID:16648887

  18. Case report of sarcoma of the sella caused by postoperative radiotherapy for a prolactin-producing pituitary adenoma.

    PubMed

    Kurosaki, Masamichi; Kambe, Atsushi; Ishibashi, Minako; Watanabe, Takashi; Horie, Yasushi

    2014-07-01

    We report a case of sarcomatous transformation of a prolactin (PRL)-producing pituitary adenoma in a 27-year-old man. He originally presented with bitemporal visual disturbance, headache, and hyperprolactinemia 8 years earlier. Tumor shrinkage was confirmed by magnetic resonance imaging (MRI) during treatment with dopamine-receptor agonist. However, 3 years later transsphenoidal surgery had to be performed because of tumor re-growth. Histopathological examination revealed a PRL-producing adenoma with fibrotic changes. One year later, he presented with right-sided visual disturbance, and tumor re-growth was confirmed using MRI. He underwent transcranial surgery, followed by radiation therapy (50 Gy in 25 fractions). The histological and immunostaining features were similar in both specimens obtained from the two operations. Four years later, he presented with left-sided visual disturbance, and tumor re-growth was confirmed using MRI. The mass lesion dramatically increased in size within 2 months, and partial removal of the tumor by craniotomy was performed. The specimen was histologically diagnosed as malignant fibrous histiocytoma (MFH). Regardless of aggressive chemotherapy, his clinical symptoms and imaging findings worsened rapidly. He died 7 months after the diagnosis of MFH. Because patients with pituitary tumor undergoing radiotherapy face the possibility of developing such neoplasm, long-term follow-up is required. PMID:24446079

  19. Expanded Endoscopic Endonasal Approaches to Skull Base Meningiomas

    PubMed Central

    Prosser, J. Drew; Vender, John R.; Alleyne, Cargill H.; Solares, C. Arturo

    2012-01-01

    Anterior cranial base meningiomas have traditionally been addressed via frontal or frontolateral approaches. However, with the advances in endoscopic endonasal treatment of pituitary lesions, the transphenoidal approach is being expanded to address lesions of the petrous ridge, anterior clinoid, clivus, sella, parasellar region, tuberculum, planum, olfactory groove, and crista galli regions. The expanded endoscopic endonasal approach (EEEA) has the advantage of limiting brain retraction and resultant brain edema, as well as minimizing manipulation of neural structures. Herein, we describe the techniques of transclival, transphenoidal, transplanum, and transcribiform resections of anterior skull base meningiomas. Selected cases are presented. PMID:23730542

  20. New Anatomical Description of the Cavernous Sinus Surface and Its Significance in Microsurgery

    PubMed Central

    Prescher, Andreas; Brors, Dominik; von Ammon, Klaus

    1997-01-01

    The anatomical and surgical approach to the sella region is of special interest for microsurgeons involved in ear, nose, and throat surgery, neurosurgery, ophthalmology, maxillofacial surgery, and skull base surgery. We investigated the surface morphology of the cavernous sinus and the sella turcica in 48 adult and 2 neonate specimens. To simplify the morphometric recording, distances between anatomical landmarks were defined. In addition, three triangles—the preinfundibular, the parasellar, and the internal carotid artery triangle—are introduced. These triangles are defined in order to determine the location where cranial nerves III, IV, V, and VI penetrate the dura with respect to the anterior and posterior clinoid processes and the tuberculum and dorsum sellae. The triangles were found to be symmetrical, with identical bilateral measurements, and the entry points of the cranial nerves were found to be constant. In 17 cases (34%), we found a dehiscence of the sellar diaphragm, and in 15 cases (30%), rope-like adhesions at the pituitary stalk. ImagesFigure 5Figure 6Figure 7Figure 8Figure 9 PMID:17171029

  1. Blockade of arginine vasotocin signaling reduces aggressive behavior and c-Fos expression in the preoptic area and periventricular nucleus of the posterior tuberculum in male Amphiprion ocellaris.

    PubMed

    Yaeger, C; Ros, A M; Cross, V; Deangelis, R S; Stobaugh, D J; Rhodes, J S

    2014-05-16

    Many marine fishes change sex in response to social cues when the dominance hierarchy is perturbed. Arginine-vasotocin (AVT) and the mammalian homolog arginine vasopressin are neuropeptides involved in social and reproductive behaviors across vertebrate taxa. The goal of this study was to determine whether AVT signaling influences aggression and expression of c-Fos, a marker of neuroplasticity, in key brain regions of the social decision circuit in Amphiprion ocellaris clownfish, a species where behavioral dominance precedes gonadal sex change from male to female. In experiment 1, juvenile clownfish (average mass 2.5g) were paired together in a tank (a total of 24 pairs), matched approximately for size with one fish randomly receiving either an intraperitoneal injection of the arginine vasopressin V1a receptor antagonist (Manning compound) or saline vehicle, and evaluated for aggressive and submissive behaviors over a 10-min period. The second experiment was a repeat of the first using five pairs of mature, reproductive males, except the animals interacted for 90-min immediately followed by euthanasia for immunohistochemical detection of c-Fos protein. Numbers of c-Fos-positive cells were quantified in the preoptic area of the hypothalamus (POA), the anterior tuberal nucleus (aTn), and periventricular nucleus of the posterior tuberculum (TPp). Manning compound significantly reduced aggression and the probability of winning the contest relative to saline (vehicle) controls. In experiment 2, saline-treated fish displayed approximately twice as many c-Fos-positive cells in the POA and 25% more in the TPp than the Manning-treated fish, no differences were observed in the aTn. Taken together, results suggest AVT signaling is necessary for aggressive behavior and expression of neuroplasticity in the POA and TPp that likely contributes to behavioral dominance and hence, sex change in A. ocellaris. PMID:24631675

  2. Partial hypopituitarism in a patient with a pituitary stone.

    PubMed

    Mroueh, A; Salti, I

    1978-11-01

    A case of sexual infantilism was found to have calcification within the sella turcica. Endocrine evaluation revealed partial hypopituitarism involving gonadotrophin and growth hormone secretion. PMID:719913

  3. Advances in Imaging of the Pediatric Pituitary Gland.

    PubMed

    Bou-Ayache, Jad M; Delman, Bradley N

    2016-06-01

    High-resolution MRI of the pediatric sella can help identity or confirm clinical abnormalities, assess pituitary gland size and structure, and reveal acquired lesions. This article reviews contemporary techniques for imaging of the sella and associated structures in this population. Strengths and weaknesses of conventional imaging are discussed, as are techniques that can enhance yield. Some new and emerging technologies are discussed, including MR elastography, perfusion imaging, spectroscopy, and diffusion-weighted and diffusion-tensor imaging. It is expected that this overview will provide insight as to where pediatric sella imaging is currently and where it may head in the future. PMID:27241974

  4. Stages of Pituitary Tumors

    MedlinePlus

    ... tumors that may spread to bones of the skull or the sinus cavity below the pituitary gland. ... sella (the bone at the base of the skull , where the pituitary gland sits). Recurrent Pituitary Tumors ...

  5. General Information about Pituitary Tumors

    MedlinePlus

    ... tumors that may spread to bones of the skull or the sinus cavity below the pituitary gland. ... sella (the bone at the base of the skull , where the pituitary gland sits). Recurrent Pituitary Tumors ...

  6. Treatment Option Overview (Pituitary Tumors)

    MedlinePlus

    ... tumors that may spread to bones of the skull or the sinus cavity below the pituitary gland. ... sella (the bone at the base of the skull , where the pituitary gland sits). Recurrent Pituitary Tumors ...

  7. Treatment Options for Pituitary Tumors

    MedlinePlus

    ... brain, including the sella (the bone at the base of the skull , where the pituitary gland sits). ... sphenoid bone (a butterfly-shaped bone at the base of the skull ) to reach the pituitary gland . ...

  8. A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors.

    PubMed

    Graffeo, Christopher S; Dietrich, August R; Grobelny, Bartosz; Zhang, Meng; Goldberg, Judith D; Golfinos, John G; Lebowitz, Richard; Kleinberg, David; Placantonakis, Dimitris G

    2014-08-01

    Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations. PMID:24014055

  9. Slack brain in meningioma surgery through lateral supraorbital approach

    PubMed Central

    Romani, Rossana; Silvasti-Lundell, Marja; Laakso, Aki; Tuominen, Hanna; Hernesniemi, Juha; Niemi, Tomi

    2011-01-01

    Background: Surgery of skull base meningiomas by the lateral supraorbital (LSO) approach requires relaxed brain. Therefore, we assessed combined effects of the elements of neuroanesthesia on neurosurgical conditions during craniotomy. Methods: The anesthesiological and surgical charts of 66 olfactory groove, 73 anterior clinoidal, and 52 tuberculum sellae meningioma patients operated on by the senior author (J.H.) at the Department of Neurosurgery of Helsinki University Central Hospital, Helsinki, Finland, between September 1997 and August 2010, were retrospectively analyzed. Results: One-hundred fifty-four (82%) patients had good surgical conditions, and this was achieved by (1) elevating the head 20 cm above the cardiac level in all patients with only slightly lateral turn or neck flexion, (2) administering mannitol preoperatively in medium or large meningiomas (n = 60), (3) maintaining anesthesia with propofol infusion (n = 46) or volatile anesthetics (n = 107) also in patients with large tumors (n = 37), and (4) controlling intraoperative hemodynamics. Brain relaxation was satisfactory in 18 (10%) and poor in 15 (8%) patients. The median intraoperative blood loss was 200 (range, 0-2000) ml. Only 9% of patients received red blood cell transfusion. The median time to extubation was 18 (range, 8-105) min after surgery. Extubation time correlated with the patients’ preoperative clinical status and the size of tumor but not with the modality of anesthesia. Conclusions: Slack brain during the LSO approach is achieved by correct patient positioning, preoperative mannitol, either by propofol or in small tumors inhaled anesthetics, and optimizing cerebral perfusion pressure. Under these circumstances, intraoperative brain swelling is prevented, bleeding is minimal, and no blood transfusions are needed. PMID:22145086

  10. A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors

    PubMed Central

    Graffeo, Christopher S.; Dietrich, August R.; Grobelny, Bartosz; Zhang, Meng; Goldberg, Judith D.; Golfinos, John G.; Lebowitz, Richard; Kleinberg, David; Placantonakis, Dimitris G.

    2014-01-01

    Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations. PMID:24014055

  11. Morphometric measurements of the cranium in congenital bilateral blind males and females

    PubMed Central

    Kosif, Rengin; Sirmatel, Ocal; Canan, Arzu

    2013-01-01

    Cranium dimensions differ according to racial, geopraphic, ethnic and nutritional factors. This study will shed light on the question “Is there a difference in the cranial distances measured between congenital bilateral blind people and healthy individuals?” Nine anthropometric measures were performed on the brain MRI midsagittally obtained from male and female congenital bilateral blinds. The anthropometric measures taken included the glabella-opisthocranion, nasion-dorsum sellae, dorsum sellae-opisthocranion, nasion-basion, nasion-opisthion, basion-opisthion, prosthion-basion, basion-vertex and the clival angle. In addition, the supratentorial and infratentorial areas were calculated. Glabella-opisthocranion, nasion-dorsum sellae, nasion-basion, prosthion-basion and clival angle were found to be smaller in the congenital bilateral blind females compared to the healthy group, but these results were not statistically significant. Whereas, other measures out of the basion-opisthion were found to be smaller in the congenital bilateral blind males than in the healthy subjects. Of these results, the distance between glabella-opisthocranion, nasion-dorsum sellae and nasion-basion was significantly smaller compared to the measurements taken from the healthy male group. The infratentorial area was significantly smaller in congenital blind male subjects and the supratentorial area was significantly larger in congenital blind female subjects. This study has revealed that the cranium dimensions of congenital blind people are to different from normal individuals. The most significant difference was in the distance of the nasion-dorsum sellae. The region anterior to the basion and dorsum sellae was prominently smaller. The infratentorial area was significantly smaller in congenital blind male subjects and the supratentorial area was significantly larger in congenital blind female subjects. PMID:24289759

  12. Do horizontal growers grow horizontally?

    PubMed

    Bookstein, F L; Moyers, R E

    1982-01-01

    It is common to analyse the growth direction of the facial skeleton by registering serial lateral cephalograms on Sella and orienting along Sella-Nasion. The present paper reports an exercise in cephalometric growth analysis by an alternate method the study of mean growth tensors. The authors conclude that conventional cephalometric techniques are inadequate for precise analysis and practical prediction of craniofacial change and that cephalometrics should proceed independently of any orientation or registration at all, with analyses following from the phenomenon, not preceding it. PMID:6963772

  13. Transsphenoidal hypophysectomy: postsurgical CT findings

    SciTech Connect

    Dolinskas, C.A.; Simeone, F.A.

    1985-03-01

    Transsphenoidal surgery produces changes in the paranasal sinuses and sella that should be familiar to radiologists in view of frequency of this type of surgery. Some of these changes, such as soft-tissue-density debris in the sinuses, are transient. Fat and other packing material identifiable in the sinuses and sella after surgery is permanent. The procedure is associated with a variety of complications that are readily detectable by computed tomography (CT). These include bleeding, compression of parasellar structures by packing material, cerebrospinal fluid leaks, and pneumocephalus. After a transsphenoidal procedure, with or without follow-up radiation therapy, residual enhancing intrasellar and parasellar lesions may still be identified.

  14. Frontiers in European radiology

    SciTech Connect

    Baert, A.L.; Boijsen, E.; Fuchs, W.A.; Heuck, F.H.W.

    1984-01-01

    This book contains the following five chapters: Modern Evaluation of the Sella Turcica; Clinical Experience with digital Subtraction Angiography; Brain Ultrasonography in the Infant: A Review; An Integrated 3-D Image of Cerebral Blood Vessels and CT View of Tumor; and Pulmonary Edema and Shock Lung: Roentgenographic Observations on Pathologic Fine Structure of the Lung.

  15. Neurocysticercosis, Meningioma, and Silent Corticotroph Pituitary Adenoma in a 61-Year-Old Woman

    PubMed Central

    Ramirez, Maria del Pilar; Restrepo, Juan E.; Syro, Luis V.; Rotondo, Fabio; Londoño, Francisco J.; Penagos, Luis C.; Uribe, Humberto; Horvath, Eva; Kovacs, Kalman

    2012-01-01

    We report here the case of a 61-year-old woman who presented with hydrocephalus and cystic and solid lesions in sella turcica, suprasellar areas, and third ventricle. After ventriculoperitoneal shunt she developed cognitive changes and the cystic lesions enlarged. Magnetic resonance imaging (MRI) demonstrated multiple cysts and a solid lesion in the sella and around the anterior clinoid process. With diagnosis of neurocysticercosis she underwent craniotomy. Pathologic examination documented two different lesions: viable and dead cysticerci with inflaming infiltration and a left anterior clinoidal meningioma. At the second surgery, six weeks later via transnasal transsphenoidal approach a silent corticotroph pituitary adenoma was removed which was studied by histology, immunohistochemistry, and electron microscopy. To our knowledge, the occurrence of these three different lesions in the sellar area was not described before. PMID:23346440

  16. A pituitary abscess masquerading as recurrent hypernatremia and aseptic meningitis.

    PubMed

    Gonzales, Michael; Marik, Paul Ellis; Khardori, Romesh K; O'Brian, John T

    2012-01-01

    Pituitary abscess is a rare condition. In the setting of multiple surgical interventions, the risk of its development increases. A 49-year-old man presented with episodes of altered mental status. He had two surgeries for a recurrent suprasellar arachnoid cyst. The second surgery was complicated by a persistent cerebrospinal fluid (CSF) leak that required two repairs following which he developed panhypopituitarism and central diabetes insipidus. Twelve months after his last surgery he was diagnosed with aseptic meningitis. This was followed by recurrent hospitalisations for severe hypernatremia blamed on poor medication compliance. He was subsequently hospitalised for the evaluation of a febrile illness. Brain MRI showed ventriculitis and enhancement of the sella. Exploratory surgery revealed a purulent collection in the sella and a mucosal graft which had been used to repair the CSF leak. After drainage of pus and replacement of the graft he recovered completely but requiring life-long hormonal replacement. PMID:22751424

  17. A pituitary abscess masquerading as recurrent hypernatremia and aseptic meningitis

    PubMed Central

    Gonzales, Michael; Marik, Paul Ellis; Khardori, Romesh K; O'Brian, John T

    2012-01-01

    Pituitary abscess is a rare condition. In the setting of multiple surgical interventions, the risk of its development increases. A 49-year-old man presented with episodes of altered mental status. He had two surgeries for a recurrent suprasellar arachnoid cyst. The second surgery was complicated by a persistent cerebrospinal fluid (CSF) leak that required two repairs following which he developed panhypopituitarism and central diabetes insipidus. Twelve months after his last surgery he was diagnosed with aseptic meningitis. This was followed by recurrent hospitalisations for severe hypernatremia blamed on poor medication compliance. He was subsequently hospitalised for the evaluation of a febrile illness. Brain MRI showed ventriculitis and enhancement of the sella. Exploratory surgery revealed a purulent collection in the sella and a mucosal graft which had been used to repair the CSF leak. After drainage of pus and replacement of the graft he recovered completely but requiring life-long hormonal replacement. PMID:22751424

  18. Isolated double pituitary adenomas: A silent corticotroph adenoma and a microprolactinoma.

    PubMed

    Eytan, Shira; Kim, Ki-Yoon; Bleich, David; Raghuwanshi, Maya; Eloy, Jean Anderson; Liu, James K

    2015-10-01

    We report a 27-year-old woman with amenorrhea and galactorrhea with mildly elevated serum prolactin levels. Her MRI demonstrated a cystic macroadenoma in the left aspect of the sella and a small microadenoma in the right aspect of the sella. Endoscopic transsphenoidal resection of the tumors revealed two histologically distinct tumors. The left tumor was consistent with a silent corticotroph macroadenoma and the right tumor was a prolactin producing microadenoma. Isolated double pituitary adenomas that are clearly separated by normal pituitary gland tissue are extremely rare. The incidence is approximately 0.37-2.6%. The coexistence of double adenomas can pose diagnostic and management challenges for the pituitary neuroendocrine team. PMID:26067545

  19. Cell types in the pituitary of the roach, Rutilus rutilus (L.), (Teleostei).

    PubMed Central

    Jafri, S I; Ensor, D M

    1980-01-01

    The pituitary of roach, Rutilus rutilus (L.), is pear-shaped and situated in the sella turcica. It is characterised by a large pars nervosa, which penetrates deep into the other regions, splitting the proximal pars distalis. Spatial localisation of nerve fibre types and glandular cell types occurs. Using a variety of staining techniques six glandular cell types have been localised and their distribution is disucssed in relation to those of the other teleost pituitaries. PMID:6159340

  20. Congenital hypopituitarism in a 48-year old adult. Natural course, hormonal study and MRI evidence.

    PubMed

    Pentimone, F; Riccioni, S; Del Corso, L

    1999-12-01

    A case of Congenital Hypopituitarism (CH) in an untreated 48 yr-old-man is reported. The hormonal studies demonstrated a panhypopituitarism and MR imaging revealed absence of pituitary stalk, small anterior pituitary remnant on the sella floor and ectopic neurohypophysis at the tuber cinereum. The pattern of hormonal responsiveness suggests that CH encompasses findings typical of primary anterior pituitary disease and those of hypothalamic dysfunction. PMID:10705718

  1. Congenital hypopituitarism in a 48-year old adult. Natural course, hormonal study and MRI evidence.

    PubMed

    Pentimone, F; Riccioni, S; Del Corso, L

    1999-06-01

    A case of Congenital Hypopituitarism (CH) in an untreated 48 yr-old-man is reported. The hormonal studies demonstrated a panhypopituitarism and MR imaging revealed absence of pituitary stalk, small anterior pituitary remnant on the sella floor and ectopic neurohypophysis at the tuber cinereum. The pattern of hormonal responsiveness suggests that CH encompasses findings typical of primary anterior pituitary disease and those of hypothalamic dysfunction. PMID:10941429

  2. [A case of suprasellar arachnoid cyst followed up for a long time].

    PubMed

    Kaisho, Y; Miyazaki, S; Shimo-oku, M; Hayashi, T; Tani, E

    1995-01-01

    We followed a case of suprasellar arachnoid cyst for 12 years. The patient was a sixteen-year-old girl without particular problems in her general condition. She showed optic atrophy in both eyes and optic nerve hypoplasia with an inferotemporal quandranopsia in the left eye. A suprasellar arachnoid cyst communicating with the tubarachnoid space was found to extend into the sella turcica as an empty sella. A cyst wall was resected and a cyst-peritoneal shunt performed. After 12 years from the operation, sensitivity was slightly depressed in the visual field where it had already been disturbed. Although there are few reports in the literature on involvement of the optic nerves and chiasma by suprasellar arachnoid cysts, papilledema and optic atrophy are often found in children, and infero-temporal quandranopsia or homonymous hemianopsia have been reported. Visual field defects were most likely caused by compression of the optic nerve by cyst or prolonged papilledema. We also suspect that some kind of disturbance to the optic nerve occurred during extension of the arachnoid cyst as an empty sella, or during formation of arachnoid cyst in the fetus stage. PMID:7887322

  3. Sellar Chondroma with Endocrine Dysfunction that Resolved after Surgery: Case Report.

    PubMed

    Hattori, Yujiro; Tahara, Shigeyuki; Nakakuki, Takuya; Takei, Mao; Ishii, Yudo; Teramoto, Akira; Morita, Akio

    2015-01-01

    Chondromas originating from the sella turcica are rare, and the most common initial symptoms are headache and visual disturbance. We describe a case of sellar chondroma with endocrine impairment as an initial manifestation that completely resolved after surgery. A 40-year-old Japanese woman with amenorrhea and galactorrhea for the last 2 years was referred to our department of neurosurgery for the evaluation of high prolactin levels and a tumor in the sella turcica. A biochemical assessment indicated endocrine dysfunction. Magnetic resonance imaging and computed tomography indicated a tumor in the sella turcica. The patient's presentation favored the preoperative diagnosis of pituitary adenoma or Rathke's cleft cyst. However, because calcification was detected, other types of tumors, such as craniopharyngioma, meningioma, and chordoma, were also considered. Endoscopic transsphenoidal surgery was performed, and the possibility of a bony tumor was recognized. Finally, the tumor was completely removed, and the histopathological findings confirmed chondroma. The postoperative course was uneventful, and endocrine function improved. Five years after surgery, the patient is doing well without pituitary insufficiency, pituitary hormone medications, or signs of tumor recurrence. In cases of sellar chondroma, endocrine dysfunction sometimes precedes other symptoms, such as headache and visual disturbance. When examining a patient with an intrasellar tumor harboring calcification, clinicians must consider the possibility of sellar chondroma. Furthermore, to the best of our knowledge, this case is the first of sellar chondroma treated with endoscopic surgery to be reported. PMID:26156668

  4. Metastatic Mantle Cell Lymphoma to the Pituitary Gland: Case Report and Literature Review

    PubMed Central

    Wang, Arthur; Carberry, Nathan; Solli, Elena; Kleinman, George; Tandon, Adesh

    2016-01-01

    We present an unusual case of a metastatic mantle cell lymphoma (MCL) to the pituitary gland. The patient had a known history of MCL for which she previously received chemotherapy. She presented with new-onset diplopia and confusion, and reported a history of progressive vision blurriness associated with headache, nausea, and vomiting. MRI of the brain showed an enhancing lesion within the sella turcica involving the cavernous sinuses bilaterally, extending into Meckel's cave on the left, and abutting the optic nerves bilaterally. Following surgical excision, histopathology revealed the tumor to be a MCL. Metastatic pituitary tumors are rare and have been estimated to make up 1% of tumors discovered in the sellar region. The two most common secondary metastatic lesions to the sella are breast and lung carcinoma followed by prostate, renal cell, and gastrointestinal carcinoma. Metastatic lymphoma to the pituitary gland is especially rare and is estimated to constitute 0.5% of all metastatic tumors to the sella turcica. To our knowledge, this is the first reported case of MCL metastasizing to the pituitary gland. PMID:26933415

  5. Facies interfingering and synsedimentary tectonics on late Ladinian-early Carnian carbonate platforms (Dolomites, Italy)

    NASA Astrophysics Data System (ADS)

    Keim, Lorenz; Brandner, Rainer

    2001-03-01

    A stratigraphic model for carbonate platform evolution in the Dolomites during the late Ladinian-early Carnian is presented. New light on pre-Raibl growth of individual carbonate platforms of the western Dolomites was shed by biostratigraphic data combined with a revised lithostratigraphy. At the Schlern, Langkofel and Sella, the carbonate factory (Upper Schlern Dolomite) remained productive into the lowermost Carnian (Cordevolian = Aon Zone), and caused a levelling-out of the former steep platform-to-basin relief. In the eastern Dolomites, platforms were producing till basal Julian 2 (Austriacum Zone). At the Sella and Langkofel, the sedimentation pattern after deposition of the Upper Schlern Dolomite was strongly influenced by synsedimentary tectonics. A first phase of extensional tectonics led to local fissures, block-tilting, graben structures and breccia deposits. Composition and fabric of the reworked clasts argue for local-source sediments and short transport distances. The extensional structures are sealed by sediments of Lower Carnian age. Two facies belts (Schlernplateau beds and Dürrenstein Dolomite), which interfinger at the western side of the Sella, reflect the shallow marine environment with terrigenous-volcanoclastic input in the western Dolomites. A second generation of breccias at the Sella documents local fracturing of the Dürrenstein and Upper Schlern Dolomite. Depositional environments across the western and eastern Dolomites were largely dependent on differential subsidence. The sediments of early Carnian age on top of the Schlern platform are a few metres thick only, whereas, in the eastern Dolomite, up to 400-m-thick carbonate sediments ('Richthofen reef' and Settsass platform) were deposited. The most incomplete stratigraphic record is present at the Mendel platform in the west, where Ladinian volcanics are unconformably overlain by late Carnian 'Raibl beds'. The increase in sediment thickness towards the eastern Dolomites becomes partly

  6. Maxillary expansion with the memory screw: a preliminary investigation

    PubMed Central

    Halicioğlu, Koray; Kiki, Ali

    2012-01-01

    Objective The purpose of this study was to investigate the effects of a newly developed rapid maxillary expansion screw-the memory screw-over 6 months. Methods Five subjects, aged between 11.7 and 13.75 years, were enrolled in this study. All subjects underwent placement of a maxillary expansion appliance containing superelastic nickel-titanium open-coil springs in its screw bed. The parents of the patients and/or the patients themselves were instructed to activate the expansion screw by 2 quarter-turns 3 times a day (morning, midday, and evening; 6 quarter-turns a day). The mean expansion period was 7.52 ± 1.04 days. Dentoskeletal effects of the procedure, including dentoalveolar inclination, were evaluated. Measurements of all the parameters were repeated after 6 months of retention in order to check for relapse. Results Sella-Nasion-A point (SNA) and Sella-Nasion/Gonion-Menton angles increased, and Sella-Nasion-B point (SNB) angle decreased in all the subjects during the expansion phase. However, they approximated to the initial values at the end of 6 months. On the other hand, the increments in maxillary apical base (Mxr-Mxl) and intermolar widths was quite stable. As expected, some amount of dentoalveolar tipping was observed. Conclusions The newly developed memory expansion screw offers advantages of both rapid and slow expansion procedures. It widens the midpalatal suture and expands the maxilla with relatively lighter forces and within a short time. In addition, the resultant increments in the maxillary apical base and intermolar width remained quite stable even after 6 months of retention. PMID:23112935

  7. Imaging and interventions in idiopathic intracranial hypertension: A pictorial essay.

    PubMed

    Sivasankar, Rajeev; Pant, Rochan; Indrajit, Inna K; Negi, Raj S; Sahu, Samresh; Hashim, P I; D'Souza, John

    2015-01-01

    Intracranial hypertension is a syndrome of elevated intracranial pressure that can be primary or secondary. The primary form, now termed idiopathic intracranial hypertension (IIH), was in the past a disease of exclusion and imaging played a limited role of excluding organic causes of raised intracranial pressure. However imaging markers have been described with patients with IIH at the orbit, sella and cerebral venous system. We wish to reiterate the characteristic imaging features of this poorly understood disease and also emphasise that stenting of the transverse sinus in select cases of IIH is an efficacious option. PMID:26752823

  8. Imaging and interventions in idiopathic intracranial hypertension: A pictorial essay

    PubMed Central

    Sivasankar, Rajeev; Pant, Rochan; Indrajit, Inna K; Negi, Raj S; Sahu, Samresh; Hashim, PI; D’Souza, John

    2015-01-01

    Intracranial hypertension is a syndrome of elevated intracranial pressure that can be primary or secondary. The primary form, now termed idiopathic intracranial hypertension (IIH), was in the past a disease of exclusion and imaging played a limited role of excluding organic causes of raised intracranial pressure. However imaging markers have been described with patients with IIH at the orbit, sella and cerebral venous system. We wish to reiterate the characteristic imaging features of this poorly understood disease and also emphasise that stenting of the transverse sinus in select cases of IIH is an efficacious option. PMID:26752823

  9. Endonasal Endoscopic Management of Parasellar and Cavernous Sinus Meningiomas.

    PubMed

    Lobo, Bjorn; Zhang, Xin; Barkhoudarian, Garni; Griffiths, Chester F; Kelly, Daniel F

    2015-07-01

    The management of cavernous sinus and invasive parasellar meningiomas often requires a multimodality treatment approach. Early attempts at complete or near-complete removal of parasellar meningiomas involving the cavernous sinus, Meckel cave, clivus, and sella using anterolateral or lateral skull base approaches were typically unsuccessful and yielded high rates of new cranial neuropathy and other complications. This article presents a strategy of endonasal endoscopic parasellar skull base bony decompression and limited tumor removal followed by stereotactic radiotherapy, stereotactic radiosurgery, or observation. Patient selection, technical nuances, potential complications, and initial outcomes in a small series of patients are discussed. PMID:26141358

  10. An unusual intracranial metallic foreign bodies and panhypopituitarism.

    PubMed

    Lakouichmi, Mohammed; Baïzri, Hicham; Mouhsine, Abdelilah; Boukhira, Abderrahmane; Akhaddar, Ali

    2014-01-01

    A 49 years old man, with a history of aggression at the age of 18 years by a pair of scissors, who consulted for unilateral migraine headaches look straight. Paraclinical explorations concluded that trauma to anterior pituitary by a metallic foreign body from the right nostril to the sella, responsible for panhypopituitarism and sinusitis. The headaches are frequent causes of consultation, often treated symptomatically but rarely explored. The direct trauma to the pituitary gland, by a metallic foreign body, is exceptional. We report the case of neglected panhypopituitarism, discovered 31 years after injury with a pair of scissors. PMID:25667695

  11. Internal carotid artery agenesis with stenosed intercavernous anastomosis: a case report

    PubMed Central

    Duan, Hongzhou; Li, Liang; Zhao, Guiping; Zhang, Yang; Zhang, Jiayong

    2016-01-01

    Abstract We report a rare case of internal carotid artery agenesis with stenosed intercavernous anastomosis. A 59-year-old male patient presented with a new infarction in the left basal ganglia. Magnetic resonance angiography and cerebral angiography showed that the right internal carotid artery disappeared from the origin to the foramen lacerum segment, and there was an anastomotic artery with severe stenosis passed through the floor of the sella and in front of the cavernous sinus. The right A1 segment of the anterior cerebral artery was absent and A2 segment was supplied by the normal contralateral internal carotid artery via the anterior communicating artery. PMID:27231043

  12. Liliequist membrane: radiological evaluation, clinical and therapeutic implications*

    PubMed Central

    Dias, Daniel Aguiar; Castro, Fábio Luiz Onuki; Yared, James Henrique; Lucas Júnior, Ademar; Ferreira Filho, Luiz Alves; Ferreira, Nelson Fortes Paes Diniz

    2014-01-01

    In a simplistic and succinct way, Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies. In spite of being well known to neurosurgeons, many radiologists neither know this anatomical structure nor give importance to its study. The imaging evaluation of this membrane is feasible and may be interesting for a better preoperative planning; postoperative evaluation of third ventriculostomies; and understanding of suprasellar arachnoid cysts and perimesencephalic hemorrhage. The present article illustrates the anatomy of the membrane, with emphasis on imaging findings, besides describing its possible clinical and surgical implications. PMID:25741076

  13. Intravenous digital subtraction angiography in the investigation of intracranial disease

    SciTech Connect

    DeFilipp, G.J.; Pinto, R.S.; Lin, J.P.; Kricheff, I.I.

    1983-07-01

    Eighty-six patients who presented with a variety of intracranial lesions were examined with intravenous digital subtraction angiogrphy (IV-DSA). A grading system was used to evaluate the ability IV-DSA to answer specific diagnostic questions regarding intracranial tumors, vasospasm following subarachnoid hemorrhage, lesions of the sella, dural sinus occlusion, and post-therapeutic embolization. Eighty-four percent of the examinations provided clinically useful information. In 15% of the cases limited but useful information was obtained; only 1% of the examinations provided no useful information. We conclude that IV-DSA can routinely provide useful information in the evaluation of the variety of intracranial lesions described above.

  14. Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology.

    PubMed

    Hari Kumar, K V S; Dhull, Pawan; Somasekharan, Manoj; Seshadri, K

    2012-01-01

    Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr's disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty. PMID:23806989

  15. Bilateral carotid aneurysms unmasked by severe hypopituitarism.

    PubMed Central

    Michils, A.; Balériaux, D.; Mockel, J.

    1991-01-01

    We describe a patient who initially presented with severe hyponatraemia and grand mal seizures, without any focal neurological symptoms. The final diagnosis was that of giant bilateral carotid aneurysms extending into the sella turcica with anterior hypopituitarism. To the best of our knowledge, this is the first case report of symmetrical carotid aneurysms manifested exclusively by an acute endocrine emergency with none of the concomitant usual focal signs such as headache, failing vision, oculomotor palsy or subarachnoid hemorrhage. Images p286-a Figure 1 PMID:2062778

  16. Ocular neuromyotonia after radiation therapy

    SciTech Connect

    Lessell, S.; Lessell, I.M.; Rizzo, J.F. III

    1986-12-15

    Ocular neuromyotonia is a paroxysmal monocular deviation that results from spasm of eye muscles secondary to spontaneous discharges from third, fourth, or sixth nerve axons. We observed this rare disorder in four patients who had been treated with radiation for tumors in the region of the sella turcica and cavernous sinus. Based on these cases and four others identified in the literature it would appear that radiation predisposes to a cranial neuropathy in which ocular neuromyotonia may be the major manifestation. Radiation appears to be the most common cause of ocular neuromyotonia.

  17. Parkinsonism: a rare manifestation of craniopharyngioma.

    PubMed

    Parvaresh, Mansour; Azar, Maziar; Ghalaenovi, Hossein; Fattahi, Arash

    2015-01-01

    Craniopharyngioma is a non-glial, non-malignant intracranial tumor of ectodermal origin, which arises from a remnant of Rathke's pouch. This tumor accounts for 5.6 to 13% of intracranial tumors in children. This paper discusses a case of craniopharyngioma in a five-year-old boy. An MRI scan of his brain showed a huge sella and supra sella cystic-solid lesion that had invaded the prepontine and interpeduncular cisterns, filling of 3rd ventricle and hydrocephalus. The patient operated via interhemispheric subfrontal through lamina terminalis and the tumor dissected from all part of brain stem and total resection achieved. After surgery Parkinsonism was worse for 3 days and levodopa started for 3 days. Parkinsonism was gone and after one week levodopa discontinued. This case practically implied that decompression of mass effect of tumor on brain stem and short-term management with levodopa can improve Parkinsonism due to midline compressive brain tumors without basal ganglia involvement. PMID:26120410

  18. Lyme disease associated neuroretinitis - Case report.

    PubMed

    Vanya, Melinda; Fejes, Imre; Jako, Maria; Tula, Areta; Terhes, Gabriella; Janaky, Marta; Bartfai, Gyorgy

    2015-12-01

    We describe a rare case of Lyme disease complicated by unilateral neuroretinitis in the right eye. We report a case of a 27-year-old woman with blurred vision on her right eye. Because of the suspicion of optic neuritis (multiplex sclerosis) neurological examination was ordered. Surprisingly, computer tomography of the brain revealed incomplete empty sella, which generally results not monocular, but bilateral optic nerve swelling. Opthalmological examination (ophthalmoscopy and optical coherence tomography) indicated not only monocular optic nerve, but retinal oedema next to the temporal part of the right optic disk. Visual evoked potentials (VEP) demonstrated no P100 latency delay and mild differences between the amplitudes of the responses of the left and right eye. Optical coherence tomography (OCT) demonstrated the swelling of the optic nerve head and oedematous retina at the temporal part of the disk. Suspicion of an inflammatory cause of visual disturbance blood tests was ordered. Doxycycline treatment was ordered till the result of the blood test arrived. The Western blot and ELISA test were positive for Borrelia burgdorferi sensu lato. Following one week corticosteroide and ceftriaxone treatments, the patient displayed a clinical improvement. Unilateral neuroretinitis with optic disk swelling due to neuroborreliosis is a rare complication and in many cases it is difficult to distinguish between inflammatory and ischemic lesions. Further difficulty in the diagnosis can occur when intracranial alterations such as empty sella is demonstrated by CT examination. PMID:26689876

  19. Pituitary aspergillus infection.

    PubMed

    Moore, Lauren A; Erstine, Emily M; Prayson, Richard A

    2016-07-01

    Fungal infection should be considered in the differential diagnosis of a pituitary or sellar mass, albeit fungal infections involving the pituitary gland and sella are a rare occurrence. We report a case of Aspergillus infection involving the pituitary gland and sellar region discovered in a 74-year-old man. The patient had a history of hypertension, chronic renal disease, autoimmune hemolytic anemia and presented with right eye pain, headaches and worsening hemiparesis. Imaging studies revealed a right internal carotid artery occlusion and an acute right pontine stroke along with smaller infarcts in the right middle cerebral artery distribution. Clinically, the patient was thought to have vasculitis. An infectious etiology was not identified. He developed respiratory distress and died. At autopsy, necrotizing meningitis was discovered. A predominantly chronic inflammatory cell infiltrate consisting of benign-appearing lymphocytes, plasma cells and macrophages was accompanied by acute angle branching, angioinvasive hyphae which were highlighted on Gomori methenamine silver staining and were morphologically consistent with Aspergillus species. In previously reported cases of Aspergillus infection involving the pituitary or sella, most presented with headaches or impaired vision and were not immunocompromised. A transsphenoidal surgical approach is recommended in suspected cases in order to minimize the risk of dissemination of the infection. Some patients have responded well to antifungal medications once diagnosed. PMID:26896907

  20. Cephalometric comparison of cesarean and normal births

    PubMed Central

    Goymen, Merve; Topcuoglu, Tolga; Aktan, Ali Murat; Isman, Ozlem

    2016-01-01

    Objective: The aim of this study was to compare cephalometric variables of subjects with normal and cesarean births. Materials and Methods: Ninety age- and gender-matched patients, who were treated in Gaziantep University, Faculty of Dentistry Orthodontics Department were equally divided into normal and cesarean groups according to the birth methods reported by their mothers. To eliminate the negative effects of being different in terms of age and gender among parameters, control, and patient groups were matched in the present study. Pretreatment cephalometrics radiographs were used. Six measurements representing sagittal and vertical relationships were evaluated from pretreatment cephalograms using Dolphin Imaging Orthodontics Software was used in this issue by an orthodontist. Kolmogorov–Smirnov test, Student's t-test, and Mann–Whitney U-test were used for statistical comparisons. Results: A point-nasion-B point angle (ANB) and Wits values were higher in the normal group, while sella-nasion-A point angle, sella-nasion-B point angle, Frankfort horizontal-mandibular plane angle, and gonion-gnathion-SN plane angle values were higher in the cesarean group. However, the groups showed no significant differences (P > 0.05). ANB angle and Wits values showed high correlation. Conclusions: Within the study limitations, the results suggest that the birth method may not have a considerable effect on the development of the craniofacial skeletal system. PMID:27095896

  1. Extrahypophysial distribution of corticotropin as a function of brain size.

    PubMed Central

    Moldow, R; Yalow, R S

    1978-01-01

    Determination by radioimmunoassay of corticotropin in the brains of rats, rabbits, dogs, monkeys, and human beings reveals that the dimensions within which the hormone is found is about the same for each of these species but that the anatomical regions in which the hormone is found depends on brain size. Corticotropin is widely distributed in the brain of rats but is found only in the hypothalamic region of the primate brain. The patterns of immunoreactivity observed after Sephadex gel filtration confirm that the molecular forms of corticotropin found in extrahypophysial regions are similar to those in the pituitary of each species. These findings suggest that the mammalian pituitary is the sole site of synthesis of the hormone. The observation of persistence of corticotropin in the brains of commerically hypophysectomized rats has been interpreted by others as suggesting diencephalic as well as pituitary origin for this peptide. However, our studies demonstrate that 8 weeks after hypophysectomy the rats we have received from commerical sources manifest stress-stimulated plasma corticotropin concentrations about 80% of that found in intact rats in spite of the fact that residual pituitary tissue was not found by visual inspection of the sella. Scrapings from the sella revealed a corticotropin content up to 5% that of the average rat pituitary. Images PMID:204943

  2. A cross-sectional study on the relationship between craniofacial morphology and the coronoid process.

    PubMed

    Torisu, Takahiro; Yamada, Kazuhiro; Fukui, Tadao; Yamaki, Masaki; Nakamura, Junichi; Saito, Isao

    2009-12-01

    Although there have been some reports on the relationship between craniofacial morphology and the activity of the temporal muscle attached to the coronoid process, such relationship is still unclear. The aim of the present study was therefore to investigate the relationship between the coronoid process and overall craniofacial morphology using lateral cephalograms of 60 female subjects (mean age 9.6 years) without mandibular deviation. Statistical testing was undertaken using stepwise regression analysis. Anterior coronoid marginal depth correlated negatively (r = 0.71) with gonial angle, SNA, and overjet. The coronoid angle also correlated negatively (r = 0.86) with both the vertical and horizontal lengths from sella to the coronoid tip as well as with the horizontal length from sella to the posterior ramus margin. Furthermore, the coronoid length correlated positively (r = 0.61) with the coronoid angle and the anterior coronoid marginal depth. The coronoid width was also positively (r = 0.69) correlated with overbite. Coronoid process morphology is related not only to mandibular morphology and position but also to maxillary position and the dental relationship in the anterior region. It therefore seems clear that coronoid process morphology might be related to temporal muscle functioning and its associated craniofacial morphological measurements. PMID:19622629

  3. Transsphenoidal Resection of Sellar Tumors Using High-Field Intraoperative Magnetic Resonance Imaging

    PubMed Central

    Szerlip, Nicholas J.; Zhang, Yi-Chen; Placantonakis, Dimitris G.; Goldman, Marc; Colevas, Kara B.; Rubin, David G.; Kobylarz, Eric J.; Karimi, Sasan; Girotra, Monica; Tabar, Viviane

    2011-01-01

    There has been increasing experience in the utilization of intraoperative magnetic resonance imaging (iMRI) for intracranial surgery. Despite this trend, only a few U.S centers have examined the use of this technology for transsphenoidal resection of tumors of the sella. We present the largest series in North America examining the role of iMRI for pituitary adenoma resection. We retrospectively reviewed our institutional experience of 59-patients who underwent transsphenoidal procedures for sellar and suprasellar tumors with iMRI guidance. Of these, 52 patients had a histological diagnosis of pituitary adenoma. The technical results of this subgroup were examined. A 1.5-T iMRI was integrated with the BrainLAB (Feldkirchen, Germany) neuronavigation system. The majority (94%) of tumors in our series were macroadenomas. Seventeen percent of tumors were confined to the sella, 49% had suprasellar extensions without involvement of the cavernous sinus, 34% had frank cavernous sinus invasion. All patients underwent at least one iMRI, and 19% required one or more additional sets of intraoperative imaging. In 58% of patients, iMRI led to the surgeon attempting more resection. A gross total resection was obtained in 67% of the patients with planned total resections. There was one case of permanent postoperative diabetes insipidus and no other instances of new hormone replacement. In summary, iMRI was most useful for tumors of the sella with and without suprasellar extension where the information from the iMRI extended the complete resection rate from 40 to 72% and 55 to 88%, respectively. As one would expect, it did not substantially increase the rate of resection of tumors with cavernous sinus invasion. Overall, iMRI was particularly useful in guiding resection safely, aiding in clinical decision making, and allowing identification and preservation of the pituitary stalk and normal pituitary gland. Limitations of the iMRI include a need for additional personnel and training

  4. Proposed clinical internal carotid artery classification system

    PubMed Central

    Abdulrauf, Saleem I; Ashour, Ahmed M; Marvin, Eric; Coppens, Jeroen; Kang, Brian; Hsieh, Tze Yu Yeh; Nery, Breno; Penanes, Juan R; Alsahlawi, Aysha K; Moore, Shawn; Al-Shaar, Hussam Abou; Kemp, Joanna; Chawla, Kanika; Sujijantarat, Nanthiya; Najeeb, Alaa; Parkar, Nadeem; Shetty, Vilaas; Vafaie, Tina; Antisdel, Jastin; Mikulec, Tony A; Edgell, Randall; Lebovitz, Jonathan; Pierson, Matt; Pires de Aguiar, Paulo Henrique; Buchanan, Paula; Di Cosola, Angela; Stevens, George

    2016-01-01

    Introduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. Materials and Methods: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment. Results: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%]; P < 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%]; P < 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%]; P < 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%; P < 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%]; P < 0.0001); (6) sphenoid segment (lateral loop of ICA within the

  5. The radiology of transsphenoidal hypophysectomy: a review of 100 cases.

    PubMed

    Rothman, S L; Kier, E L; Allen, W E

    1976-10-01

    This report describing the radiology of transsphenoidal hypophysectomy based on a review of 100 consecutive surgical procedures. Preoperative laminographic evaluation of the sphenoid sinus is an important aid in planning the most direct surgical approach to the pituitary. It is also useful in defining the many anatomic structures that may be injured inadvertently at the time of surgery. Intraoperative radiography or fluoroscopy is helpful in identifying the sella floor and as an aid in preventing loss of orientation within a capacious sinus. Various changes occur within the sphenoid sinus following surgery, some transient and others persistent. The surgical defect is usually difficult to identify on routine roentgenograms but is clearly visible on lateral laminography. A persistent soft tissue mass within the sinus is usually a manifestation of fascia and fat placed as a seal within the sinus. PMID:970530

  6. Transsphenoidal pituitary resection with intraoperative MR guidance: preliminary results

    NASA Astrophysics Data System (ADS)

    Pergolizzi, Richard S., Jr.; Schwartz, Richard B.; Hsu, Liangge; Wong, Terence Z.; Black, Peter M.; Martin, Claudia; Jolesz, Ferenc A.

    1999-05-01

    The use of intraoperative MR image guidance has the potential to improve the precision, extent and safety of transsphenoidal pituitary resections. At Brigham and Women's Hospital, an open-bore configuration 0.5T MR system (SIGNA SP, GE Medical Systems, Milwaukee, WI) has been used to provide image guidance for nine transsphenoidal pituitary adenoma resections. The intraoperative MR system allowed the radiologist to direct the surgeon toward the sella turcica successfully while avoiding the cavernous sinus, optic chiasm and other sensitive structures. Imaging performed during the surgery monitored the extent of resection and allowed for removal of tumor beyond the surgeon's view in five cases. Dynamic MR imaging was used to distinguish residual tumor from normal gland and postoperative changes permitting more precise tumor localization. A heme-sensitive long TE gradient echo sequence was used to evaluate for the presence of hemorrhagic debris. All patients tolerated the procedure well without significant complications.

  7. Pituitary adenoma with seizures: PET demonstration of reduced glucose utilization in the medial temporal lobe

    SciTech Connect

    Bairamian, D.; Di Chiro, G.; Blume, H.; Ehrenberg, B.

    1986-05-01

    A patient with a benign chromophobe adenoma, who had incomplete surgical removal followed by radiotherapy, continued to have epileptic seizures up to two or three times a day. She was studied with positron emission tomography using /sup 18/F-2-deoxyglucose (FDG). This technique showed a high level of glucose utilization in the area of the operated tumor but also clear reduction of glucose utilization in the left medial temporal region adjacent to the sella and the scar tissue from the neoplasm. This area of reduced glucose utilization corresponded well to the same finding observed in other patients with complex partial epilepsy. A left temporal anterior lobectomy was carried out followed by improved control of the epilepsy. Positron emission tomography using FDG, together with electrophysiological examinations, may assist in the management of epilepsy related to pituitary tumors.

  8. Do We Need Hormonal Screening In Patients With Subcentimeter Pituitary Microadenomas?

    PubMed

    Martínez-Méndez, José Hernán; Gutiérrez-Acevedo, Madeleine; Palermo-Garofalo, Coromoto; Miranda-Adorno, María de Lourdes; Mangual-García, Michelle; Sánchez-Cruz, Alfredo; Rivera-Anaya, Carmen; Mansilla-Letelier, Paola; Laboy-Ortiz, Ivan

    2015-01-01

    A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm. PMID:26434093

  9. More than just a ‘runny nose’: a rare diagnosis of spontaneous CSF rhinorrhoea for a common symptom

    PubMed Central

    Berhanu, Aaron Elias; Pauli, Natalie P

    2014-01-01

    Summary Primary spontaneous cerebral spinal fluid (CSF) rhinorrhoea is a rare disease associated with female gender, obesity and empty sella syndrome. The authors describe the case of a 59-year-old woman who presented to her primary care physician with a 2-week history of drainage of a clear fluid from her right nostril that was initially treated as allergic rhinitis. A non-contrast CT scan revealed mucosal thickening in the right sphenoid sinus and a possible defect in the adjacent skull base. The patient initially declined a CT cisternogram, which provides greater sensitivity in assessing for a CSF leak. Nasal secretions tested positive for β-2-transferrin, which is highly sensitive and specific for CSF. After conservative interventions failed, a pedicled septal mucoperichondrial flap was used to patch the skeletal defect. At her 5-month follow-up, the patient remains asymptomatic. PMID:25150242

  10. [Preservation of gonadotrophic function and pregnancy in Sheehan's syndrome: a case report and review of the literature].

    PubMed

    Vieira, H B; Knoepfelmacher, M; Salgado, L R; Wajchenberg, B L; Liberman, B

    1995-01-01

    Pregnancy occurring in patient with Sheehan's syndrome is seldom described. It depends on the preservation of LH and FSH secretion after the pituitary apoplexy event. PURPOSE--To report a patient with Sheehan's syndrome who became pregnant twice after the pituitary apoplexy episode and to discuss the maintenance of gonadotrophic function. METHOD--Clinical aspects are described and the pituitary reserve evaluation was performed as well as a computerized tomography and a magnetic resonance imaging of the brain. RESULTS--Gonadotrophic and thyrotrophic function were preserved and the neuroradiologic evaluation disclosed an empty sella turcica preservation of the posterior lobe of the hypophysis. CONCLUSION--A patient with Sheehan's syndrome is reported in whom the LH and FSH pituitary secretion was preserved allowing normal pregnancy twice after the pituitary apoplexy. PMID:8520595

  11. 68Ga DOTATATE PET/CT of Synchronous Meningioma and Prolactinoma.

    PubMed

    Basu, Sandip; Ranade, Rohit; Hazarika, Suman

    2016-03-01

    Ga DOTATATE PET/CT in noninvasive characterization of synchronous pituitary neoplasm and meningioma in a 38-year-old man is illustrated. The patient presented with an MRI-detected lobulated enhancing sellar-suprasellar mass with erosion of bony sella measuring 4.5 × 3.5 × 3.4 cm (with differential diagnosis with germ cell tumor) and a right parafalcine mass (2.7 × 2.6 cm) suggesting meningioma. Ga DOTATATE PET/CT demonstrated intense uptake in both lesions, suggesting the sellar mass to be pituitary macroadenoma. The finding of high serum prolactin and normal LH, FSH, cortisol, and testosterone levels suggested diagnosis of prolactinoma, and the patient was started on cabergoline. PMID:26462040

  12. Atypical Case of Congenital Maxillomandibular Fusion with Duplication of the Craniofacial Midline

    PubMed Central

    Martín, Lorena Pingarrón; Pérez, Mercedes Martín; García, Elena Gómez; Martín-Moro, Javier González; González, Jose Ignacio Rodríguez; García, Miguel Burgueño

    2011-01-01

    We report the first case of syngnathia with hypophyseal duplication and describe the central nervous system (CNS) and craniofacial anomalies associated with hypophyseal duplication in the reported autopsy case. We studied clinical reports, scanner images, and autopsy results of a 2-months-old female baby. The propositus had frontonasal dysmorphism, retrognathia, and bifid tongue. She also presented maxillomandibular bony fusion (syngnathia) and an intraoral hairy polyp. In the cranium, the sella turcica was broadened, with two complete hypophyses and two infundibulums. The CNS had both olfactory bulbs and corpus callosum agenesis. There are 27 previous cases of maxillomandibular fusion and seven previous autopsy cases of hypophyseal duplication associated with other frontonasal malformations. As far as the authors know, this is the first case reported in the literature that associates syngnathia with duplication of the craniofacial midline including hypophyseal duplication. PMID:22655122

  13. [Pituitary abscess. A case report (author's transl)].

    PubMed

    Guy, G; Jallet, G; Bigorgne, J C

    The case of a patient with apparently primitive pituitary abscess is presented along with a review of the current literature on the subject. Pituitary abscess is rare and should be suspected in patients with hypopituitarism or a febrile chiasma syndrome as well as in the presence of acute or chronic relapsing aseptic meningitis. Diagnosis is based upon radiologic examination particularly tomography of the sella turcica and computerized axial tomography. With early surgical treatment the prognosis is favourable resulting at times in partial or total correction of pituitary function. Twenty-six patients were studied. In twelve of these patients no origin of the abscess was found. Pituitary tumor was found in eight patients and sphenoidal sinusitis in six patients. PMID:6261360

  14. Acromegaly and diabetes mellitus associated with hyperthyroidism.

    PubMed

    Deng, Datong; Luo, Li; Chen, Mingwei; Xu, Min; Wang, Youmin

    2014-01-01

    A 66-year-old woman with acromegaly and diabetes mellitus as well as primary hyperthyroidism is described. Serum GH Levels were inappprpriately high.MRI revealed an enlarged sella turcica with intrasellar mass. Her HbAlc was 12.2% and fasting blood glucose 8.89 mmol/l. Thyroid hormone levels in serum and thyroidal radioiodine uptake values were elevated, while TSH measurements in serum were low. Anti TPO antibodies were negative, TSH receptor antibodies were normal. Thyrotoxicosis as the first presenting illness in acromegaly was particulary uncommon. An ultrasound thyroid scan showed a multinodular goiter. Histology of the pituitary lesion showed a typical eosinophilic adenoma which only secreted GH when tested with specific immunostain. Post-operatively, the patient's clinical conditions improved, however, secondary hypoadrenalism appeared. PMID:24977962

  15. MRI of paraganglioma of the filum terminale

    SciTech Connect

    Boncoeur-Martel, M.P.; Lesort, A.; Moreau, J.J.; Labrousse, F.; Roche, I.; Bouillet, P.; Pascaud, J.L.; Dupuy, J.P.

    1996-01-01

    Paragangliomas are benign tumors arising from paraganglionic cells of the sympathetic nervous system. They are of neuroectodermal derivation, with the majority occurring in the adrenal medulla. Extraadrenal locations are usually nonfunctioning and mostly observed (90%) in the head and neck region (carotid body or glomus jugulare tumors). Rare reported locations include the mediastinum, retroperitoneum, lungs, duodenum, and bladder. Within the CNS, paragangliomas have been observed in the pineal region, petrous ridge, sella turcica, and spinal canal. Paraganglioma of the cauda equina was first reported, but not recognized as such, in 1970. We know of 10 reports that describe MRI appearance. We present a new case and review the imaging findings of a paraganglioma of the filum terminale. 14 refs., 3 figs.

  16. Clinical computed tomography: Illustrated procedural guide

    SciTech Connect

    Chiu, L.C.; Lipcamon, J.D.; Yie-Chiu, B.S.

    1986-01-01

    This book presents an overview of physics and instrumentation. It addresses the role of the CT technologist; discusses the use of contrast media, its potential complications, and their avoidance, discusses techniques for scanning the brain, sella, orbits, petrous temporal bones, paranasal sinuses, neck, thorax, abdomen, pelvis, and spine; and demonstrates the normal anatomy of the foregoing regions. All this is followed by 171 examples of disease; a chapter on CT-guided biopsy and drainage procedures; and a description, in tabular form, of six different models of CT scanners, with the parameters for 15 separate examinations tabulated for each model of machine. The scanning techniques are presented in recipe fashion without clear reasons for the choices made or discussion on how choices can be varied for different clinical problems. They are also oriented toward one model of CT scanner. The anatomic sections are good but can be found in numerous other publications.

  17. Benign Intracranial Hypertension: A Diagnostic Dilemma

    PubMed Central

    Shaw, Gary Y.; Million, Stephanie K.

    2012-01-01

    Benign intracranial hypertension (BIH) (also known as pseudotumor cerebri and empty sella syndrome) remains a diagnostic challenge to most physicians. The modified Dandy criteria consist of, the classic findings of headache, pulsatile tinnitus, papilledema, and elevated cerebrospinal fluid (CSF) pressure, however, these are rarely collectively present in any one patient. Furthermore, these findings can wax and wane over time. Due to the nature of this disease, both signs and symptoms may be intermittent, making definitive diagnosis difficult. Newer imaging studies, particularly the magnetic resonance venogram (MRV) along with a constellation of correlative findings and associated diseases have given new impetus in the diagnosis, treatment, and pathophysiology of this disease. This has led the authors to offer modifications to the classic Dandy criteria. This report presents three representative cases of BIH highlighting many of the newer advances in both diagnosis and treatment of this perplexing disorder. PMID:22928139

  18. Removal of craniopharyngioma via fronto-basal interhemispheric approach

    PubMed Central

    XING, HONGSHUN; XING, HONGBO; HUI, PEIQUAN; YANG, BIN

    2016-01-01

    The effectiveness and safety of fronto-basal interhemispheric approach in treating craniopharyngioma were evaluated. In this retrospective study, the safety and effectiveness of fronto-basal interhemispheric approach for surgical resection of craniopharyngioma in 20 patients was analyzed. Of the 20 patients, 12 were men and 8 were women, aged 15–65 years, with an average age of 42.5 years. The course of disease ranged from 1 to 36 months. The craniopharyngioma tumor was completely removed through surgical resection in 18 patients (90%) and partially removed in 2 patients. The pituitary stalk was preserved in 18 patients and 1 patient succumbed during the study period due to large area pulmonary embolism. In conclusion, fronto-basal interhemispheric approach provides better access to the tumor that grows in the sella-hypothalamus and anterior third ventricle region. Using this approach, tumors can be resected while preserving the vital structures such as the pituitary stalk and hypothalamus. PMID:27347116

  19. Suspected neurotoxicity due to Clostridium perfringens type B in a tiger (Panthera tigris).

    PubMed

    Zeira, Offer; Briola, Chiara; Konar, Martin; Dumas, Maria Pia; Wrzosek, Marcin Adam; Papa, Valentina

    2012-09-01

    A 4-yr-old tiger (Panthera tigris) was referred with acute onset of severe abnormal consciousness. Neurological evaluation showed normal palpebral and corneal reflexes, normal pupil diameter with normal direct and consensual papillary light reflex, and absent menace response bilaterally. Diffuse forebrain lesion or focal lesion affecting the ascending reticular activating system was suspected. Complete blood examination and cerebrospinal fluid analysis were normal. Magnetic resonance imaging of the brain showed an empty sella as the only result. Clostridium perfringens 10(4) to 10(7) colony-forming units/g were detected in fecal flora samples. Multiplex polymerase chain reaction assay identified serotype B counts with production of epsilon toxin. This toxin specifically accumulates in the central nervous system, where it causes acute neurological signs in humans, domestic animals, and wildlife. In this communication, the acute onset of neurological signs without evidence of trauma, vascular, metabolic, or inflammatory diseases may be caused by neurotoxicity due to C. perfringens. PMID:23082539

  20. A surgical case of paraclinoid carotid aneurysm associated with ipsilateral cervical internal carotid artery dissection.

    PubMed

    Takeuchi, Satoru; Wada, Kojiro; Sakakibara, Fumihiro; Mori, Kentaro

    2012-01-01

    This report presents a 60-year-old with a large paraclinoid carotid aneurysm associated with cervical interal carotid artery (ICA) dissection (CICAD). She had a fall while riding a bicycle and hit her head on the ground. Computed tomography scan done at another facility showed a round mass lesion near the sella. Her medical history revealed gradual decrease in left eye vision since two years. Left carotid artery digital subtraction angiography demonstrated a CICAD with an intimal flap and a large paraclinoid aneurysm (15.5 mm in size). She underwent a high-flow bypass with a so-called double-insurance bypass and proximal ligation of the cervical ICA and the postoperative course was uneventful. She was discharged without any new neurological deficits. We suggest that the possible nature of carotid artery dissection (CAD)-related hemodynamic changes should be taken into consideration in cases of intracranial aneurysm associated with CAD. PMID:23135031

  1. Calculating nasoseptal flap dimensions: a cadaveric study using cone beam computed tomography.

    PubMed

    Ten Dam, Ellen; Korsten-Meijer, Astrid G W; Schepers, Rutger H; van der Meer, Wicher J; Gerrits, Peter O; van der Laan, Bernard F A M; Feijen, Robert A

    2015-09-01

    We hypothesize that three-dimensional imaging using cone beam computed tomography (CBCT) is suitable for calculating nasoseptal flap (NSF) dimensions. To evaluate our hypothesis, we compared CBCT NSF dimensions with anatomical dissections. The NSF reach and vascularity were studied. In an anatomical study (n = 10), CBCT NSF length and surface were calculated and compared with anatomical dissections. The NSF position was evaluated by placing the NSF from the anterior sphenoid sinus wall and from the sella along the skull base towards the frontal sinus. To visualize the NSF vascularity in CBCT, the external carotic arteries were perfused with colored Iomeron. Correlations between CBCT NSFs and anatomical dissections were strongly positive (r > 0.70). The CBCT NSF surface was 19.8 cm(2) [16.6-22.3] and the left and right CBCT NSF lengths were 78.3 mm [73.2-89.5] and 77.7 mm [72.2-88.4] respectively. Covering of the anterior skull base was possible by positioning the NSF anterior to the sphenoid sinus. If the NSF was positioned from the sella along the skull base towards the frontal sinus, the NSF reached partially into the anterior ethmoidal sinuses. CBCT is a valuable technique for calculating NSF dimensions. CBCT to demonstrate septum vascularity in cadavers proved to be less suitable. The NSF reach for covering the anterior skull base depends on positioning. This study encourages preoperative planning of a customized NSF, in an attempt to spare septal mucosa. In the concept of minimal invasive surgery, accompanied by providing customized care, this can benefit the patients' postoperative complaints. PMID:25359192

  2. Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation

    PubMed Central

    Ismail, Mostafa; Fares, Abd Alla; Abdelhak, Balegh; D’Haens, Jean; Michel, Olaf

    2016-01-01

    Objectives: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. Methods: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A – with no intrasellar packing, Group B – with haemostatic materials packing, and Group C – with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. Results: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. Conclusions: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our

  3. Characterization of Sphenoid Sinuses for Sudanese Population Using Computed Tomography

    PubMed Central

    Kajoak, Samih A.; Ayad, Caroline Edward; Balla, Elsafi Ahmed Abdalla; Najmeldeen, Mohammed; Yousif, Mohammed; Musa, Alamin

    2014-01-01

    The purpose of this study is to determine the anatomical features of the sphenoid sinus using computerized tomography (CT). 100 Sudanese subjects were investigated for CT sinuses; Characterization of the sphenoid sinus and seven horizontal and vertical measurements were evaluated. Onodi cell was found in 13 subjects, 10 of them were sellar and 3 were pre-sellar. Pneumatization was of the sellar type in 85%, presellar was 15%, and no subject was chonchal. The mean length of vertical lines from the center of sphenoid ostium to the roof and bottom were 10.6 ± 3.1 mm, 11.1 ± 3.7 mm respectively. When the sphenoid ostium was located superior to the lowest point of the sella, the line from the center of the sphenoid sinus ostium to the posterior wall of the sinus was 15.2 ± 4.2 mm and when was located inferior, the line was 26.3 ± 5.2 mm on average. The mean length from the lowest point of the sella to the anterior wall of sphenoid sinus was 16.8 ± 3.6 mm. The line from anterior wall to posterior wall of sphenoid sinus lining skull base was 10.9 ± 3.2mm mm. The maximum depth was 25.2 ± 6.9 mm and the maximum width was 18.4 ± 5.9mm. The differences in the sphenoid sinus character take place between males and females. The study provides essential anatomical information for Sudanese subjects and its impact in the clinical surgical practice. PMID:24373273

  4. Persistence of intrasellar trigeminal artery and simultaneous pituitary adenoma: description of two cases and their importance for the differential diagnosis of sellar lesions.

    PubMed

    Machado, Marcio Carlos; Kodaira, Sergio; Musolino, Nina Rosa Castro

    2014-08-01

    Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the carotid and vertebrobasilar systems. However, hormonal changes or the association of PTA with other sellar lesions, such as pituitary adenomas, are extremely rare. The aim of the present study was to report two patients with intrasellar PTA and simultaneous pituitary adenoma in order to emphasize the importance of differential diagnoses for sellar lesions. Case 1. A female patient, 41 years old, was admitted with a history of chronic headache (> 20 years). Pituitary magnetic resonance imaging (MRI) showed a rounded lesion in the left portion of the pituitary gland suggestive of adenoma (most likely clinically non-functioning adenoma). In addition to this lesion, the MRI demonstrated ecstasy of the right internal carotid artery and imaging suggestive of an intrasellar artery that was subsequently confirmed by an angio-MRI of the cerebral vessels as PTA. Case 2. A female patient, 42 years old, was admitted with a history of amenorrhea and galactorrhea in 1994. Laboratorial investigation revealed hyperprolactinemia. Pituitary MRI showed a small hyposignal area in the anterior portion of pituitary gland suggestive of a microadenoma initiated by a dopaminergic agonist. Upon follow-up, aside from the first lesion, the MRI showed a well delineated rounded lesion inside the pituitary gland, similar to a vessel. Angio-MRI confirmed a left primitive PTA. Failure to recognize these anomalous vessels within the sella might lead to serious complications during transsphenoidal surgery. Therefore, although their occurrence is uncommon, a working knowledge of vascular lesions in the sella turcica or pituitary gland is important for the differential diagnosis of pituitary lesions, especially pituitary adenomas. PMID:25211451

  5. Portlandemys gracilis n. sp., a New Coastal Marine Turtle from the Late Jurassic of Porrentruy (Switzerland) and a Reconsideration of Plesiochelyid Cranial Anatomy

    PubMed Central

    Anquetin, Jérémy; Püntener, Christian; Billon-Bruyat, Jean-Paul

    2015-01-01

    Background Several groups of stem cryptodires became adapted to coastal marine environments as early as the Late Jurassic, 40 million years before the Pan-Chelonioidea. The Plesiochelyidae are a major component of this first radiation of crown-group turtles into marine habitats. They are abundant in many European localities, but their systematics is still greatly confused. Only three species are represented by cranial material: Plesiochelys etalloni, Plesiochelys planiceps, and Portlandemys mcdowelli. Methodology/Principal Findings In the present study, we describe a cranium and a mandible from the Kimmeridgian of Porrentruy (Switzerland), which we refer to a new species, Portlandemys gracilis n. sp. This new taxon differs from Portlandemys mcdowelli in several aspects of the cranium and mandible, notably in being generally more gracile, but the two species share a narrow skull, a more acute angle between the labial ridges on the mandible, and a unique configuration of the anterodorsal part of the basicranium. The cranial anatomy of plesiochelyid turtles is discussed in details based primarily on these new specimens and new cranial material of Plesiochelys etalloni from Solothurn, Switzerland. Conclusions/Significance Several characters (e.g., the contribution of the parietal to the foramen nervi trigemini, the configuration of the dorsum sellae and sella turcica, the presence of an infolding ridge on the posterior surface of the quadrate) appear as potential candidates to help elucidate plesiochelyid relationships. Some of these characters are included in a previously published phylogenetic dataset and help to stabilize the relationships of plesiochelyid turtles and closely related taxa. For the first time, our results suggest that plesiochelyids, 'Thalassemys' moseri, and Solnhofia parsonsi (representing the Eurysternidae) form a clade at the base of Eucryptodira. PMID:26106888

  6. Symptomatic hypothalamic-pituitary dysfunction in nasopharyngeal carcinoma patients following radiation therapy: a retrospective study

    SciTech Connect

    Lam, K.S.; Ho, J.H.; Lee, A.W.; Tse, V.K.; Chan, P.K.; Wang, C.; Ma, J.T.; Yeung, R.T.

    1987-09-01

    Endocrine assessment was performed in 32 relapse-free southern Chinese patients 5-17 years following radiation therapy (RT) alone for early nasopharyngeal carcinoma (NPC). Initial screening was done using questionnaires emphasizing impaired sexual function and menstrual disturbance plus measurement of serum levels of thyroxine, free thyroxine index, thyrotropic hormone, prolactin, and additionally testosterone for males only. Those showing abnormalities were subjected to detailed pituitary function tests. Hypothalamic-pituitary dysfunction was found in 7 female patients and only 1 male patient. A delayed TSH response to thyrotropin releasing hormone suggesting a hypothalamic disorder was seen in 6 of the affected female patients, and hyperprolactinaemia in also 6. None of the patients had evidence of diabetes insipidus. Hypopituitarism became symptomatic 2-5 years after RT with a mean latent interval of 3.8 years. A practical protocol for regular endocrine assessment for NPC patients after RT has been proposed. Multiple linear regression analysis of the radiotherapeutic data from the 11 female patients indicates that the likelihood of late occurrence of symptomatic hypothalamic-pituitary dysfunction following RT is dependent on the TDF of the target dose to the nasopharyngeal region and the height of the upper margin of the opposed lateral facial fields above the diaphragma sellae (coefficient of multiple correlation = 0.9025). Except when the sphenoid sinus or the middle cranial fossa is involved, it is advisable to set the height of the upper margin of the lateral facial field at a level no higher than the diaphragma sellae. The hypothalamus and possibly the pituitary stalk as well may sustain permanent damage by doses of radiation within the conventional radiotherapeutic range for carcinomas.

  7. Sagittal synostosis: I. Preoperative morphology of the skull.

    PubMed

    Guimarães-Ferreira, José; Gewalli, Fredrik; David, Lisa; Darvann, Tron A; Hermann, Nuno V; Kreiborg, Sven; Friede, Hans; Lauritzen, Claes G K

    2006-01-01

    The aim of this study was to characterise the preoperative morphology of the skull in sagittal synostosis in an objective and quantified way. The shapes of the skulls of 105 patients with isolated premature synostosis of the sagittal suture (SS group) were studied and compared with those of a control group of 72 children with unilateral incomplete cleft lip (UICL). A standardised radiocephalometric technique was used to obtain the images. A modification of a method developed by Kreiborg was used to analyse the radiocephalograms, which included the digitisation of 88 landmarks in the calvaria, skull base, and orbit (42 in the lateral and 46 in the frontal projections), the production of plots of mean shape for each group, and the intergroup comparison of a series of 81 variables (linear distance between selected landmarks, and angles defined by groups of three landmarks). Data from a subgroup of 66 patients aged 5 to 8 months were further compared to age-matched normative data in terms of seven angular and linear calvarial, cranial base and orbital variables. In a comparative analysis of the mean lateral plots, the foreheads of the study group (SS) had a more pronounced anterior slope and were also more convex. The vertex area was located more anteriorly, and was less convex. The occipital curvature was more prominent. Analysis of the mean frontal plots revealed a lack in convexity and lateral projection of the upper parietal regions, as well as a lower location of the line of maximum skull width. Comparison of the mean values of an SS subgroup to age-matched normative data showed a longer (p<0.001) and narrower skull (p<0.001) and a greater interorbital distance (p<0.001). The cranial base angle, the sella to nasion, and sella to basion lengths did not differ significantly. Sagittal synostosis is characterised by an extensive deformity of the cranial vault, with an essentially normal cranial base. The widened interorbital distance is probably related to

  8. [Basal cell nevus syndrome. Presentation of 2 cases. 1 associated with medulloblastoma].

    PubMed

    Balsa, R E; Ingratta, S M; Galeano, F A; Raffaeli, C A; Drut, R; Vestfrid, M

    1985-01-01

    A case of nevoid basal-cell carcinoma syndrome in a four years old girl with preceding familiar history is reported. In her epithelioma father numerous basocellular, milia cysts, mandibular cysts, dentition disorders, brain falx calcifica ted and hiperkeratosis of the sole of the feet were described. Clinically, the girl presented initial migraine and vomits together with macrocephalus, bossing forehead, hypertelorism, physical disorders, retarded maturation, "keel" thorax, genu recurvatum, hallux valgus, hammerfinger, pigmented nevus and hyperkeratosis of the sole of the feet. Radiologically diastasis of the skull suture with jagged image, endocranial hypertension, signs of macrocephalus of the facial bones, calcification of the brain falx, bridge of the sella turcica, bifid ribs and fusion of the ribs was observed. The axial computed tomography showed calcification of the vermix cerebelosus and severe hydrocephalus suggesting the presence of an occupant mass. After total surgical removal of the mass, the histological examination revealed a medulloblastoma. The skin biopsy of a cutaneous nevic element showed a basal-cell epithelioma. With the exception of an ovarian fibroma and fusion of the vertebras non appreciable because of the age. With the exception of the ovarian fibroma and the fusion of the vertebras, the patient showed the same characteristics as those described in the classification of Gorlin. The importance of this paper communication lie on the preceding familiar history, infrequency, compromise of different systems, malignant tendency of the cutaneous lesions and frequent association with non cutaneous neoplasias. PMID:3887060

  9. Whole-Exome Sequencing Identifies Homozygous GPR161 Mutation in a Family with Pituitary Stalk Interruption Syndrome

    PubMed Central

    Karaca, Ender; Buyukkaya, Ramazan; Pehlivan, Davut; Charng, Wu-Lin; Yaykasli, Kursat O.; Bayram, Yavuz; Gambin, Tomasz; Withers, Marjorie; Atik, Mehmed M.; Arslanoglu, Ilknur; Bolu, Semih; Erdin, Serkan; Buyukkaya, Ayla; Yaykasli, Emine; Jhangiani, Shalini N.; Muzny, Donna M.; Gibbs, Richard A.

    2015-01-01

    Context: Pituitary stalk interruption syndrome (PSIS) is a rare, congenital anomaly of the pituitary gland characterized by pituitary gland insufficiency, thin or discontinuous pituitary stalk, anterior pituitary hypoplasia, and ectopic positioning of the posterior pituitary gland (neurohypophysis). The clinical presentation of patients with PSIS varies from isolated growth hormone (GH) deficiency to combined pituitary insufficiency and accompanying extrapituitary findings. Mutations in HESX1, LHX4, OTX2, SOX3, and PROKR2 have been associated with PSIS in less than 5% of cases; thus, the underlying genetic etiology for the vast majority of cases remains to be determined. Objective: We applied whole-exome sequencing (WES) to a consanguineous family with two affected siblings who have pituitary gland insufficiency and radiographic findings of hypoplastic (thin) pituitary gland, empty sella, ectopic neurohypophysis, and interrupted pitiutary stalk—characteristic clinical diagnostic findings of PSIS. Design and Participants: WES was applied to two affected and one unaffected siblings. Results: WES of two affected and one unaffected sibling revealed a unique homozygous missense mutation in GPR161, which encodes the orphan G protein–coupled receptor 161, a protein responsible for transducing extracellular signals across the plasma membrane into the cell. Conclusion: Mutations of GPR161 may be implicated as a potential novel cause of PSIS. PMID:25322266

  10. Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects

    PubMed Central

    Julayanont, Parunyou; Karukote, Amputch; Ruthirago, Doungporn; Panikkath, Deepa; Panikkath, Ragesh

    2016-01-01

    Idiopathic intracranial hypertension (IIH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology except empty sella turcica, optic nerve sheath with filled out cerebrospinal fluid spaces, and smooth-walled nonflow-related venous sinus stenosis or collapse. This condition typically affects obese women. The incidence of IIH is increasing with the rising prevalence of obesity. Persistent headache is the most common symptom. Visual impairment is a serious complication that may not be recognized by the patients. This paper reviews clinical manifestations, diagnostic challenges, and current treatments of IIH in adults. Various imaging modalities have been studied on their validity for detection of IIH and papilledema. This review also includes new studies on medical, surgical, and interventional management of this condition. Acetazolamide and topiramate are the only two medications that have been studied in randomized controlled trials about their efficacy in treatment of IIH. In patients who have severe visual impairment or progressive visual deterioration despite medical management, surgical or interventional treatment may be considered. The efficacy and complications of cerebrospinal fluid diversion, optic nerve sheath fenestration, and endovascular venous stenting reported in the last 3 decades have been summarized in this review. Finally, the prospective aspects of biomarkers and treatments are proposed for future research. PMID:26929666

  11. Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects.

    PubMed

    Julayanont, Parunyou; Karukote, Amputch; Ruthirago, Doungporn; Panikkath, Deepa; Panikkath, Ragesh

    2016-01-01

    Idiopathic intracranial hypertension (IIH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology except empty sella turcica, optic nerve sheath with filled out cerebrospinal fluid spaces, and smooth-walled nonflow-related venous sinus stenosis or collapse. This condition typically affects obese women. The incidence of IIH is increasing with the rising prevalence of obesity. Persistent headache is the most common symptom. Visual impairment is a serious complication that may not be recognized by the patients. This paper reviews clinical manifestations, diagnostic challenges, and current treatments of IIH in adults. Various imaging modalities have been studied on their validity for detection of IIH and papilledema. This review also includes new studies on medical, surgical, and interventional management of this condition. Acetazolamide and topiramate are the only two medications that have been studied in randomized controlled trials about their efficacy in treatment of IIH. In patients who have severe visual impairment or progressive visual deterioration despite medical management, surgical or interventional treatment may be considered. The efficacy and complications of cerebrospinal fluid diversion, optic nerve sheath fenestration, and endovascular venous stenting reported in the last 3 decades have been summarized in this review. Finally, the prospective aspects of biomarkers and treatments are proposed for future research. PMID:26929666

  12. The need for skull radiography in patients presenting for CT

    SciTech Connect

    Tress, B.M.

    1983-01-01

    One thousand patients had both CT of the head and a conventional skull series of radiographs. Radiographic findings were abnormal in 250 patients (25%), but only 64 patients (6.4%) had diagnostically significant abnormalities at radiography that were not detected by CT. If the 163 patients who presented after acute trauma were excluded from the series, only 39 (4.7%) of the remaining patients had radiographically significant abnormal findings that were not seen at CT, and only two (0.2%) of these abnormalities could not be diagnosed by a lateral skull radiograph alone. In only five patients (0.5%) was the management actively changed because an abnormaltiy that was detected at skull radiography was not detected at CT. Thus, in nontrauma patients who have stroke, epilepsy, dementia, or non-specific symptoms without focal signs, or have recently undergone craniotomy, and who have been referred for CT, skull radiographs are not justified. In the patient with a history and findings that are strongly suggestive of a pathological disorder anywhere other than in the sella turcica, cerebello-pontine angle, and paranasal sinuses, only the lateral skull radiograph should be obtained after CT, and only if CT is equivocal.

  13. Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography

    PubMed Central

    Bai, Ya; Song, Wen; Chen, Yongchao; Li, Dongxue; Han, Hui; Liu, Bin

    2015-01-01

    Purpose Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). Methods Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared. Results Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented. Conclusion The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery. PMID:26658152

  14. The eye as a window to rare endocrine disorders.

    PubMed

    Chopra, Rupali; Chander, Ashish; Jacob, Jubbin J

    2012-05-01

    The human eye, as an organ, can offer critical clues to the diagnosis of various systemic illnesses. Ocular changes are common in various endocrine disorders such as diabetes mellitus and Graves' disease. However there exist a large number of lesser known endocrine disorders where ocular involvement is significant. Awareness of these associations is the first step in the diagnosis and management of these complex patients. The rare syndromes involving the pituitary hypothalamic axis with significant ocular involvement include Septo-optic dysplasia, Kallman's syndrome, and Empty Sella syndrome all affecting the optic nerve at the optic chiasa. The syndromes involving the thyroid and parathyroid glands that have ocular manifestations and are rare include Mc Cune Albright syndrome wherein optic nerve decompression may occur due to fibrous dysplasia, primary hyperparathyroidism that may present as red eye due to scleritis and Ascher syndrome wherein ptosis occurs. Allgrove's syndrome, Cushing's disease, and Addison's disease are the rare endocrine syndromes discussed involving the adrenals and eye. Ocular involvement is also seen in gonadal syndromes such as Bardet Biedl, Turner's, Rothmund's, and Klinefelter's syndrome. This review also highlights the ocular manifestation of miscellaneous syndromes such as Werner's, Cockayne's, Wolfram's, Kearns Sayre's, and Autoimmune polyendocrine syndrome. The knowledge of these relatively uncommon endocrine disorders and their ocular manifestations will help an endocrinologist reach a diagnosis and will alert an ophthalmologist to seek specialty consultation of an endocrinologist when encountered with such cases. PMID:22629495

  15. Coexistence of intracranial germ cell tumor and craniopharyngioma in an adolescent: case report and review of the literature

    PubMed Central

    Tsoukalas, Nikolaos; Tolia, Maria; Kostakis, Ioannis D; Pistamaltzian, Nikolaos; Tryfonopoulos, Dimitrios; Lypas, Georgios; Koumakis, Georgios; Barbounis, Vasileios; Goutas, Nikolaos; Efremidis, Anna

    2013-01-01

    Purpose: We present the case of a patient treated for intracranial germ cell tumor in which elements of craniopharyngioma were found in the residual tumor mass. Findings: A 17 year old patient presented with a history of secondary amenorrhea. She deteriorated with headache and left eyelid drop, paresis of the abducent nerve and convergent strabismus (Parinaud syndrome). β-HCG was 722mIU/ml and pregnancy was excluded. AFP was 6322 ng/ml. Brain CT scan showed a large endosellar tumor to the hypersellar region. There was left papillary atrophy. MRI confirmed a tumor to dorsum sellae. Primary germ cell intracranial tumor was diagnosed. Severe clinically evident pituitary failure developed with signs of increased intracranial pressure and brain edema as well as diabetes insipidus, while AFP increased to 15786,3ng/ml. Urgent treatment with combination chemotherapy including cisplatin etoposide and bleomycin (ΡEB) was administered for 4 courses. As a result her clinical condition improved and tumor markers dropped but nevertheless did not become normal. In addition CT scans revealed a remaining endocranial mass and therefore the patient was subjected to high-dose chemotherapy followed by autologous stemcell rescue which resulted in complete clinical and biochemical remission. Due to the persisting mass in the area, it was delivered radiotherapy. Conclusions: The above case is extremely rare in worldwide literature. Dysgerminoma may coexist with craniopharyngioma which in fact may be part of a germ cell tumor in the context of dysembryogenesis and benign “teratoma”. PMID:23573353

  16. Designing Orthodontic Craniofacial Templates for 8–14 year-old Iranian Girls Based on Cephalometric Norms

    PubMed Central

    Chalipa, Javad; Akhoundi, Mohammad Sadegh Ahmad; Shoshtarimoghaddam, Elinaz; Nik, Tahereh Hosseinzadeh; Imani, Mosle

    2013-01-01

    Objectives: Cephalometry and its related analyses have an important role in the evaluation of orthodontic patients. Access to an analysis that gives maximum information in the least possible time is an effective way to indicate craniofacial disharmony; therefore, craniofacial templates are very useful tools. The purpose of the present study was to provide orthodontic craniofacial templates for 8–14-year-old Iranian girls. Materials and Methods: One thousand two-hundred and nine girls (age range, 8–14 years) were examined. Eighty of these cases were finally chosen for the study and their lateral cephalograms were traced. Both Basion-Nasion (Ba-N) and Sella-Nasion (S-N) lines were selected for superimposition in this study. Based on these two mentioned lines, a template for each age was designed. Simple linear regression and multivariant regression analysis were used to evaluate the angles and to landmark the vectors, respectively. Results: Findings show that most points change significantly at different ages in the S-N method. In the Ba-N method, all points except for S and Ba have significant changes at different ages. Conclusion: Templates that resulted from both methods were the same and alteration in the reference line and points does not change the total form of the average tracings of each age. PMID:23724204

  17. Banked Fascia Lata in Sellar Dura Reconstruction after Endoscopic Transsphenoidal Skull Base Surgery

    PubMed Central

    Fiorindi, Alessandro; Gioffrè, Giorgio; Boaro, Alessandro; Billeci, Domenico; Frascaroli, Daniele; Sonego, Massimo; Longatti, Pierluigi

    2015-01-01

    Objectives Cerebrospinal fluid (CSF) leakage is an undesirable complication of transsphenoidal skull base surgery. The issue of the most appropriate sellar dura repair remains unresolved, although a multilayer technique using autologous fascia lata is widely used. We describe the novel application of a homologous banked fascia lata graft as an alternative to an autologous one in the reconstruction of sellar dura defects in endoscopic transsphenoidal surgery. Design The clinical records of patients who underwent endoscopic transsphenoidal surgery at our department from June 2012, when we started using homologous fascia lata, up to July 2014 were reviewed retrospectively. The data concerning diagnosis, reconstruction technique, and surgical outcome were analyzed. Results We treated 16 patients successfully with banked fascia lata. Twelve patients presented intraoperative CSF leakage, and four patients were treated for postoperative rhinoliquorrhea. Banked fascia lata was used in a single-to-multilayer technique, depending on the anatomical features of the defect and of the sellar floor. No complications or failures in sella reconstruction occurred. Conclusion A banked fascia lata graft proved reliable and safe in providing an effective sellar dura reconstruction. Used in a multilayer strategy, it should be considered a viable alternative to an autologous fascia lata graft. PMID:26225321

  18. Björk-Jarabak cephalometric analysis on CBCT synthesized cephalograms with different dentofacial sagittal skeletal patterns

    PubMed Central

    Rodriguez-Cardenas, Yalil Augusto; Arriola-Guillen, Luis Ernesto; Flores-Mir, Carlos

    2014-01-01

    OBJECTIVE: The objective of this study was to evaluate the Björk and Jabarak cephalometric analysis generated from cone-beam computed tomography (CBCT) synthesized lateral cephalograms in adults with different sagittal skeletal patterns. METHODS: The sample consisted of 46 CBCT synthesized cephalograms obtained from patients between 16 and 40 years old. A Björk and Jarabak cephalometric analysis among different sagittal skeletal classes was performed. Analysis of variance (ANOVA), multiple range test of Tukey, Kruskal-Wallis test, and independent t-test were used as appropriate. RESULTS: In comparison to the standard values: Skeletal Class III had increased gonial and superior gonial angles (P < 0.001). This trend was also evident when sex was considered. For Class I males, the sella angle was decreased (P = 0.041), articular angle increased (P = 0.027) and gonial angle decreased (P = 0.002); whereas for Class III males, the gonial angle was increased (P = 0.012). For Class I females, the articular angle was increased (P = 0.029) and the gonial angle decreased (P = 0.004). Björk's sum and Björk and Jabarak polygon sum showed no significant differences. The facial biotype presented in the three sagittal classes was mainly hypodivergent and neutral. CONCLUSIONS: In this sample, skeletal Class III malocclusion was strongly differentiated from the other sagittal classes, specifically in the mandible, as calculated through Björk and Jarabak analysis. PMID:25628079

  19. Intracranial hypertension: A rare presentation of lupus nephritis

    PubMed Central

    Yadav, Praveen; Nair, Anishkumar; Cherian, Ajith; Sibi, N. S.; Kumar, Ashwini

    2010-01-01

    A 14-year-old male presented with bilateral papilledema, growth retardation and absent secondary sexual characters. He had a past history of fever, headache and fatigue of 6 months duration. The diagnosis of intracranial hypertension (IH) was confirmed by an increased intracranial pressure and normal neuroimaging studies of the brain, except for partial empty sella, prominent perioptic cerebrospinal fluid (CSF) spaces and buckling of optic nerves. Evaluation showed erythrocyte sedimentation rate (ESR) of 150 mm/hr, positive antinuclear antibody (ANA), anti dsDNA and anti ribosomal P protein. Renal biopsy revealed diffuse segmental proliferative lupus nephritis (LN) class IV S (A) confirming the diagnosis of systemic lupus erythematosus (SLE). Treatment of LN with intravenous pulse methyl prednisolone and cyclophosphamide was effective in normalizing the CSF pressure, resulting in express and dramatic resolution of symptomatology. In a case of IH, SLE must be considered. IH, growth retardation and absence of sexual characters may be presenting manifestations of a chronic systemic inflammatory disease like SLE. These manifestations may act as a pointer to associated advanced grades of LN, which can be totally asymptomatic and missed without a renal biopsy. PMID:21559160

  20. Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

    PubMed Central

    Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin

    2016-01-01

    Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea. PMID:26981520

  1. Pituitary Stone or Calcified Pituitary Tumor? Three Cases and Literature Review

    PubMed Central

    Chentli, Farida; Safer-Tabi, Amel

    2015-01-01

    Introduction: Pituitary stone or pituitary calculus is a scientific enigma characterized by a large calcification in the pituitary sella. It can be discovered incidentally or in a patient with endocrine and/or neurological problems. Its mechanism is not understood. In this article, we described three patients harboring a large pituitary calcification. Case Presentation: The first case was observed in a 27-year-old woman who consulted for secondary amenorrhea. The second case concerned a woman who consulted for infertility, and the third one was observed in an 11-year and nine-month-old girl who was sent to our department for short stature. Clinical examination was normal in both adults. The pediatric case had dwarfism with lack of pubertal development. Hormonal assessment showed hyperprolactinemia in both women and thyrotroph and somatotroph deficits in the child. Radiologic exploration discovered pituitary calcifications measuring 10, 11, and 45 mm without any cystic or solid mass. Conclusions: Radiological findings pleaded for a pituitary stone, but calcified adenomas in women, and calcified craniopharyngioma in the pediatric case could not be excluded, as our three patients were not operated on. PMID:26401144

  2. Case Report: The Specter of Untreated Congenital Hypothyroidism in Immigrant Families.

    PubMed

    Hamdoun, Elwaseila; Karachunski, Peter; Nathan, Brandon; Fischer, Melissa; Torkelson, Jane L; Drilling, Amy; Petryk, Anna

    2016-05-01

    Newborn screening has dramatically reduced rates of untreated congenital hypothyroidism (CH). However, in low-income nations where newborn screening programs do not exist, untreated CH remains a significant health and societal challenge. The goal of this report is to alert health care providers about the potential of undiagnosed CH in unscreened immigrant children. We report 3 siblings of Somali descent with CH who started treatment with levothyroxine at age 0.5 years, 7.7 years, and 14.8 years and were followed for 8 years. This case series demonstrates a spectrum of severity, response to treatment, and neurocognitive and growth outcomes depending on the age at treatment initiation. Patient 1, now 22 years old, went undiagnosed for 14.8 years. On diagnosis, his height was -7.5 SDs with a very delayed bone age of -13.5 SDs. His longstanding CH was associated with empty sella syndrome, static encephalopathy, and severe musculoskeletal deformities. Even after treatment, his height (-5.2 SDs) and cognitive deficits remained the most severe of the 3 siblings. Patient 2, diagnosed at 7.7 years, had moderate CH manifestations and thus a relatively intermediate outcome after treatment. Patient 3, who had the earliest diagnosis at 0.5 years, displayed the best response, but continues to have residual global developmental delay. In conclusion, untreated CH remains an important diagnostic consideration among immigrant children. PMID:27244801

  3. Pineal Diffuse Large B-Cell Lymphoma Concomitant With Pituitary Prolactinoma: Possible Correlation Between 2 Distinguished Pathologies

    PubMed Central

    Kim, Yeong-Jin; Kim, Hee Kyung; Yang, Deok-Hwan; Jung, Shin; Noh, Myung-Giun; Lee, Jae-Hyuk; Lee, Kyung-Hwa; Moon, Kyung-Sub

    2016-01-01

    Abstract This is the first reported case of pineal lymphoma with concomitant prolactin-producing pituitary adenoma. A 51-year-old male experienced worsening headaches accompanied by nausea, diplopia, and memory loss for 1 month. Cranial nerve examination revealed bilateral upward gaze limitation with convergence impairment, which is known as Parinaud syndrome. Magnetic resonance images revealed a mass in the pineal gland with a coexisting mass within the enlarged sella fossa. Hormone analysis revealed hyperprolactinemia. The pineal mass was removed without injuring the hypothalamus, brain stem, or any neighboring vessels. Pathology examination confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) involving the pineal gland. After further studies, the pineal lymphoma was determined to be a secondary tumor from a gastric primary tumor. The patient died 6 months after diagnosis due to systemic progression of DLBCL. Although the mechanistic link between hyperprolactinemia and lymphoma progression has not been clarified on a clinical basis, high prolactin levels may contribute to the rapid progression and therapeutic resistance of the lymphoma. PMID:26937937

  4. Forces Applied at the Skull Base during Transnasal Endoscopic Transsphenoidal Pituitary Tumor Excision

    PubMed Central

    Bekeny, James R.; Swaney, Philip J.; Webster, Robert J.; Russell, Paul T.; Weaver, Kyle D.

    2013-01-01

    Objectives Our laboratory is developing a surgical robotic system to further improve dexterity and visualization that will allow for broader application of transnasal skull base surgery. To optimize this system, intraoperative force data are required. Using a modified curette, force data were recorded and analyzed during pituitary tumor excision. Design A neurosurgical curette was modified by the addition of a force sensor. The instrument was validated in an in vitro model to measure forces during simulated pituitary tumor excision. Following this, intraoperative force data from three patients during transnasal endoscopic excision of pituitary tumors was obtained. Setting Academic medical center. Main Outcome Measures Forces applied at the skull base during surgical excision of pituitary tumors. Results Average forces applied during in vitro testing ranged from 0.1 to 0.15 N. Average forces recorded during in vivo testing ranged from 0.1 to 0.5 N. Maximal forces occurred with collisions of the bony sella. The average maximal force was 1.61 N. There were no complications related to the use of the modified curette. Conclusions Forces to remove pituitary tumor are small and are similar between patients. The in vitro model presented here is adequate for further testing of a robotic skull base surgery system. PMID:24436934

  5. Intracranial idiopathic hypertension: 1-year follow-up study.

    PubMed

    D'Amico, D; Curone, M; Erbetta, A; Farago', G; Bianchi-Marzoli, S; Ciasca, P; Bussone, G; Chiapparini, L

    2014-05-01

    Standard guidelines for ongoing management, as well as definitive data about the long-term course of idiopathic intracranial hypertension (IIH) are not available. The aim of this study was to compare several clinical and instrumental variables as assessed at the time of diagnosis and then after 1 year in a sample of IIH patients. A total of 21 patients were studied. Our results confirmed that headache and TVO are the most frequent symptoms in IIH patients, and that overweight is a very common feature. A trend towards a favorable outcome in patients followed for 1 year and treated by usual medical therapy was found: intracranial pressure was lower at follow-up; improvement of headache and transient visual obscurations, as well as of papilledema, was reported in most patients. On the other hand, neuroradiological findings (such as empty sella, perioptic subarachnoid space distension, narrowing of the transverse sinuses) were substantially stable at follow. These findings may be relevant for future research as far as understanding the role of different clinical and instrumental findings as diagnostic items as well as predictors of outcome in IIH. PMID:24867861

  6. Traumatic panhypopituitarism resulting in acute adrenal crisis.

    PubMed

    Ham, Phillip Benson; Cunningham, Aaron Joseph; Mentzer, Caleb James; Ahmad, Anbar; Young, Lester S; Abuzeid, Adel M

    2015-09-01

    Pituitary function plays an integral role in the physiologic response to traumatic injury. A significant proportion of trauma patients develop partial pituitary insufficiency. While isolated deficiencies of individual pituitary hormones are common, there are few reports in the literature of traumatic pan-pituitary failure with deficiency of all major pituitary hormones. We present a case of a patient involved in a motorcycle accident who sustained a sella turcica fracture, epidural hemorrhage, subdural hemorrhage, optic nerve palsy, and bilateral abducens nerve palsies. Three days after the accident, the patient became hypotensive and progressed to cardiopulmonary arrest. He was resuscitated and had spontaneous return of circulation. Despite adequate fluid resuscitation and vasopressor support, he remained profoundly hypotensive. Following administration of hydrocortisone, his blood pressures dramatically improved. He was found to have laboratory abnormalities, suggesting deficiencies of corticotropins, somatotropins, thyrotropins, gonadotropins, prolactin, and antidiuretic hormone. This is the first reported case of a patient with traumatic total panhypopituitarism complicated by acute adrenal crises during initial postinjury hospitalization. A review of the literature with comparison with other studies of trauma patients with deficiencies in five or more axes is presented. A high level of suspicion for central adrenal insufficiency and prompt administration of corticosteroids in the setting of symptomatic pituitary trauma can result in favorable outcomes. Screening for and treating posttraumatic hypopituitarism can result in improved rehabilitation and increased quality of life for trauma patients. PMID:26307884

  7. Measurement and analysis of internal stress distributions created in gelatin simulated-brain tissue by a pulsed laser-induced liquid jet.

    PubMed

    Kato, T; Arafune, T; Washio, T; Nakagawa, A; Ogawa, Y; Tominaga, T; Sakuma, I; Kobayashi, E

    2014-01-01

    Transsphenoidal surgery is currently employed to treat complex lesions beyond the sella turcica; however, the procedure can be limited by difficulties encountered in dealing with small blood vessels, deep and narrow working spaces, and awkward working angles. To overcome these problems, we have developed a pulsed laser-induced liquid jet system that can dissect tumor tissue while preserving fine blood vessels within deep and narrow working spaces. We have previously evaluated the utility and safety of this procedure. However, the effects of the pulsejet after being injected into the brain are not yet well understood. Especially, the behavior of the stress distribution created by the jet is important because it has recently been reported that high acoustic pressures can affect the brain. In this study, we measured internal stress distributions in a gelatin simulated-brain using photoelasticity experiments. We used a high-speed camera with an image sensor on which an array of micropolarizers was attached to measure the stresses and the shear wave created when the pulsejet enters the simulated brain. PMID:25570972

  8. Petrous apex cephalocoele: contribution of coexisting intracranial pathologies to the aetiopathogenesis

    PubMed Central

    Duran, S; Hatipoglu, H G; Cılız, D S; Elverici, E; Sakman, B

    2015-01-01

    Objective: The aim of this study was to show the MRI findings of petrous apex cephalocoele (PAC) and the other intracranial pathologies that coexist with PAC, and to discuss the contribution of the co-existing pathologies to aetiopathogenesis. Methods: A retrospective analysis of our imaging archive for the period from January 2012 to October 2013 revealed 13 patients with PAC (12 females and 1 male; age range, 26–69 years). 11 patients underwent MRI examination of the cranium, and 2 patients underwent MRI examination of the sellar region. We evaluated the lesions for content, signal intensity, enhancement, relation to petrous apex and Meckel's cave. Images were also evaluated for coexisting pathologies. Results: The presenting symptoms included headache, vertigo, cerebrospinal fluid (CSF) leak and trigeminal neuropathy. All patients had PAC. All lesions were located posterolateral to the Meckel's cave and were isointense with CSF signal on all pulse sequences. All lesions were continuous with Meckel's cave. Coexisting pathologies included intracranial aneurysmal dilatation, empty sella, mass in hypophysis, arachnoid cyst, inferior herniation of parahippocampal gyrus and optic nerve sheath CSF distension. Conclusion: Coexistence with other intracranial pathologies supports the possibility of CSF imbalance and/or intracranial hypertension in the aetiopathogenesis of PAC. Advances in knowledge: This study examined the contribution of the co-existing intracranial pathologies to the aetiopathogenesis of PAC. PMID:25651410

  9. Image-Guided Surgery of the Skull Base Using a Novel Miniature Position Sensor

    PubMed Central

    Smouha, Eric E.; Shapiro, Avishai W.; Davis, Raphael P.; Shindo, Maisie L.; Sobol, Louis L.; Acker, David E.

    1999-01-01

    Image-guided navigational systems have been a useful adjunct for minimally invasive surgery of the skull base. A novel miniature position sensor has been developed that uses a low magnetic field for real-time tracking of surgical instruments. The 1.7-mm-diameter sensor attached to the position and orientation system (Magellan®, Biosense, Inc., Johnson and Johnson Co., Baldwin Park, CA) was deployed through various surgical instruments or used in a hand-held fashion with a malleable shaft probe. We report on our experience using this electromagnetic system in a series of lesions of the sella and clivus. After patient/image registration, the system was consistently accurate to within 2 mm. We have found this system to be particularly advantageous in endoscopic surgery of cystic lesions of the skull base, where access is limited and anatomy may be distorted. In three patients, this device obviated the need for an extensive external surgical approach. Case histories are presented, which illustrate the specific advantages this miniature system provides during skull base surgery. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171125

  10. Dynamics of biosonar systems in Horseshoe bats

    NASA Astrophysics Data System (ADS)

    Müller, R.

    2015-12-01

    Horseshoe bats have an active ultrasonic sonar system that allows the animals to navigate and hunt prey in structure-rich natural environments. The physical components of this biosonar system contain an unusual dynamics that could play a key role in achieving the animals' superior sensory performance. Horseshoe bat biosonar employs elaborate baffle shapes to diffract the outgoing and incoming ultrasonic wave packets; ultrasound is radiated from nostrils that are surrounded by noseleaves and received by large outer ears. Noseleaves and pinnae can be actuated while ultrasonic diffraction takes place. On the emission side, two noseleaf parts, the anterior leaf and the sella, have been shown to be in motion in synchrony with sound emission. On the reception side, the pinnae have been shown to change their shapes by up to 20% of their total length within ˜100 milliseconds. Due to these shape changes, diffraction of the incoming and outgoing waves is turned into a dynamic physical process. The dynamics of the diffraction process results in likewise dynamic device characteristics. If this additional dynamic dimension was found to enhance the encoding of sensory information substantially, horseshoe bat biosonar could be a model for the use of dynamic physical processes in sensing technology.

  11. Sellar gangliocytoma with adrenocorticotropic and prolactin adenoma.

    PubMed

    Kissiedu, Juliana O; Prayson, Richard A

    2016-02-01

    We report a case of a 60-year-old man who presented with weight gain, headaches, dizziness, erectile dysfunction and decreased libido. He was found to have elevated adrenocorticotropic hormone (ACTH) and prolactin serum levels. The imaging studies revealed a 1.4 cm sella/suprasellar mass which was compressing the optic chiasm. Histologic slides of the lesion showed a pituitary adenoma, marked by a proliferation of biphenotypic appearing cells, associated with a gangliocytoma, and marked by a proliferation of atypical appearing neuronal cells arranged against a glial-appearing background. Pituitary adenoma-gangliocytomas are benign combination tumors that rarely occur in the sellar region. Adenomas in this setting are sometimes functional, and rare patients with mixed adenomas (adenomas secreting more than one hormone) have been reported. To our knowledge, there has been only one other report of a combined ACTH and prolactin-producing adenoma with gangliocytoma, reported in a patient who also had acromegaly. In our patient, the immunohistochemical stains demonstrated that the bulk of the adenoma cells stained with prolactin antibody, and scattered clusters of cells within the adenoma stained positively for ACTH. The adenoma did not stain with antibodies to any of the other anterior pituitary hormones. Postoperatively, the elevated prolactin and ACTH levels returned to normal levels and there was no evidence of residual tumor. Adequate sampling and immunohistochemistry are important in rendering a correct diagnosis and in identifying the hormone status of mixed adenoma-gangliocytomas. PMID:26314658

  12. Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature

    PubMed Central

    Karras, Constantine L.; Abecassis, Isaac Josh; Abecassis, Zachary A.; Adel, Joseph G.; Bit-Ivan, Esther N.; Chandra, Rakesh K.; Bendok, Bernard R.

    2016-01-01

    Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury) and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20). Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment. PMID:26885420

  13. Pineal Diffuse Large B-Cell Lymphoma Concomitant With Pituitary Prolactinoma: Possible Correlation Between 2 Distinguished Pathologies: A Case Report.

    PubMed

    Kim, Yeong-Jin; Kim, Hee Kyung; Yang, Deok-Hwan; Jung, Shin; Noh, Myung-Giun; Lee, Jae-Hyuk; Lee, Kyung-Hwa; Moon, Kyung-Sub

    2016-02-01

    This is the first reported case of pineal lymphoma with concomitant prolactin-producing pituitary adenoma.A 51-year-old male experienced worsening headaches accompanied by nausea, diplopia, and memory loss for 1 month. Cranial nerve examination revealed bilateral upward gaze limitation with convergence impairment, which is known as Parinaud syndrome. Magnetic resonance images revealed a mass in the pineal gland with a coexisting mass within the enlarged sella fossa. Hormone analysis revealed hyperprolactinemia. The pineal mass was removed without injuring the hypothalamus, brain stem, or any neighboring vessels. Pathology examination confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) involving the pineal gland. After further studies, the pineal lymphoma was determined to be a secondary tumor from a gastric primary tumor. The patient died 6 months after diagnosis due to systemic progression of DLBCL.Although the mechanistic link between hyperprolactinemia and lymphoma progression has not been clarified on a clinical basis, high prolactin levels may contribute to the rapid progression and therapeutic resistance of the lymphoma. PMID:26937937

  14. Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature.

    PubMed

    Karras, Constantine L; Abecassis, Isaac Josh; Abecassis, Zachary A; Adel, Joseph G; Bit-Ivan, Esther N; Chandra, Rakesh K; Bendok, Bernard R

    2016-01-01

    Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury) and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20). Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment. PMID:26885420

  15. Hyperprolactinemia Secondary to Allergic Fungal Sinusitis Compressing the Pituitary Gland

    PubMed Central

    Chapurin, Nikita; Wang, Cynthia; Steinberg, David M.; Jang, David W.

    2016-01-01

    Objective. We aim to describe the first case in the literature of allergic fungal sinusitis (AFS) presenting with hyperprolactinemia due to compression of the pituitary gland. Case Presentation. A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. Workup revealed elevated prolactin of 94.4, negative pregnancy test, and normal thyroid function. MRI and CT demonstrated a 5.0 × 2.7 × 2.5 cm heterogeneous expansile mass in the right sphenoid sinus with no pituitary adenoma as originally suspected. Patient was placed on cabergoline for symptomatic control until definitive treatment. Results. The patient underwent right endoscopic sphenoidotomy, which revealed nasal polyps and fungal debris in the sphenoid sinus, consistent with AFS. There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with allergic fungal sinusitis caused by Curvularia species. Prolactin levels normalized four weeks after surgery with resolution of symptoms. Conclusion. Functional endoscopic sinus surgery alone was able to reverse the patient's pituitary dysfunction. To our knowledge, this is the first case of AFS presenting as hyperprolactinemia due to pituitary compression. PMID:26998375

  16. Xanthogranuloma of the sellar region in a patient with sarcoidosis.

    PubMed

    Sulentić, Petra; Cupić, Hrvoje; Cerina, Vatroslav; Vrkljan, Milan

    2010-03-01

    Xanthogranuloma of the sellar region is a very rare brain tumor with favorable prognosis and without reported relapses of purely xanthogranulomatous lesion after complete resection. A case is presented of a 40-year-old male diagnosed with and treated for sarcoidosis, complaining of headache, photophobia and loss of libido. Physical examination revealed generally scarce hairiness, while laboratory investigations showed panhypopituitarism. Expansive sellar and suprasellar mass compressing the floor of the third ventricle and optical chiasm was confirmed by cranial multi-slice computerized tomography (MSCT). Complete resection of the tumor mass using trans-sphenoidal approach was performed. Histopathologic analysis revealed cholesterol clefts, sparse lymphoplasmacellular infiltrates, macrophages, siderophages and foreign body giant cells around cholesterol clefts confirming the diagnosis of xanthogranuloma of the sellar region. Since preoperative diagnosis of xanthogranuloma is very difficult, therapeutic algorithm does not differ from other expansive lesions of the sellar region, but pituitary involvement should always be considered in patient with sarcoidosis since therapeutic management is non-surgical. Follow up MSCT imaging after 6 months revealed a solid, contrast-enhanced mass at the posterior base of the sella. PMID:20635586

  17. Diagnosis and classification of autoimmune hypophysitis.

    PubMed

    Falorni, Alberto; Minarelli, Viviana; Bartoloni, Elena; Alunno, Alessia; Gerli, Roberto

    2014-01-01

    Autoimmmune hypophysitis (AH) is the consequence of an immune-mediated inflammation of the pituitary gland. The initial pituitary enlargement, secondary to infiltration and oedema, can evolve to remission, for spontaneous or pharmacological resolution of the inflammation, or evolve to progressive diffuse destruction with gland atrophy for fibrotic replacement, thus leading to various degrees of pituitary dysfunction. The autoimmune process against the pituitary gland is made evident by the appearance of circulating autoantibodies (APA), mainly detected by indirect immunofluorescence on cryostatic sections of human or primate pituitary. Among the target autoantigens recognized by APA are alpha-enolase, gamma-enolase, the pituitary gland specific factors (PGSF) 1 and 2 and corticotroph-specific transcription factor (TPIT). However, the low diagnostic sensitivity and specificity of APA for AH strongly limit the clinical use of this marker. AH should be considered in the differential diagnosis of non-secreting space-occupying lesions of sella turcica, to avoid misdiagnosis that may lead to an aggressive surgery approach, since endocrine dysfunction and the compressive effect may be transient. PMID:24434361

  18. Robotic Anterior and Midline Skull Base Surgery: Preclinical Investigations

    SciTech Connect

    O'Malley, Bert W. Weinstein, Gregory S.

    2007-10-01

    Purpose: To develop a minimally invasive surgical technique to access the midline and anterior skull base using the optical and technical advantages of robotic surgical instrumentation. Methods and Materials: Ten experimental procedures focusing on approaches to the nasopharynx, clivus, sphenoid, pituitary sella, and suprasellar regions were performed on one cadaver and one live mongrel dog. Both the cadaver and canine procedures were performed in an approved training facility using the da Vinci Surgical Robot. For the canine experiments, a transoral robotic surgery (TORS) approach was used, and for the cadaver a newly developed combined cervical-transoral robotic surgery (C-TORS) approach was investigated and compared with standard TORS. The ability to access and dissect tissues within the various areas of the midline and anterior skull base were evaluated, and techniques to enhance visualization and instrumentation were developed. Results: Standard TORS approaches did not provide adequate access to the midline and anterior skull base; however, the newly developed C-TORS approach was successful in providing the surgical access to these regions of the skull base. Conclusion: Robotic surgery is an exciting minimally invasive approach to the skull base that warrants continued preclinical investigation and development.

  19. Mouth breathing in allergic children: its relationship to dentofacial development.

    PubMed

    Bresolin, D; Shapiro, P A; Shapiro, G G; Chapko, M K; Dassel, S

    1983-04-01

    While there are many claims that abnormal breathing patterns alter facial growth, there are limited controlled data to confirm this. We evaluated forty-five North American Caucasians of both sexes, ranging in age from 6 to 12 years. Thirty chronically allergic mouth-breathing subjects were selected from a pediatric allergy practice, and fifteen nonallergic nose breathers were selected from a general pediatric practice. Each subject underwent an intraoral clinical examination and a cephalometric radiograph analysis. Various skeletal and dental relationships were evaluated for statistical differences related to mode of breathing and age. The upper anterior facial height and the total anterior facial height were significantly larger in the mouth breathers. Angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in the mouth breathers, and their gonial angles were larger. The mouth breathers' maxillae and mandibles were more retrognathic. Palatal height was higher, and overjet was greater in the mouth breathers. Maxillary intermolar width was narrower in the mouth breathers and was associated with a higher prevalence of posterior cross-bite. Over all, mouth breathers had longer faces with narrower maxillae and retrognathic jaws. This supports previous claims that nasal airway obstruction is associated with aberrant facial growth. Longitudinal studies are needed to evaluate the effectiveness of early intervention in preventing these growth alterations. PMID:6573147

  20. Chondroblastoma of the Clivus: Case Report and Review

    PubMed Central

    Liu, Jonathan; Ahmadpour, Arjang; Bewley, Arnaud F.; Lechpammer, Mirna; Bobinski, Matthew; Shahlaie, Kiarash

    2015-01-01

    Background and Importance Chondroblastoma is a benign primary bone tumor that typically develops in the epiphyses of long bones. Chondroblastoma of the craniofacial skeleton is extremely rare, with most cases occurring in the squamosal portion of the temporal bone. In this report, we describe the first case of chondroblastoma of the clivus presenting with cranial neuropathy that was treated with endoscopic endonasal resection. We review the literature on craniofacial chondroblastomas with particular emphasis on extratemporal lesions. Case Presentation A 27-year-old woman presented with severe headache, left facial dysesthesias, and diplopia. Physical examination revealed hypesthesia in the left maxillary nerve dermatome, and complete left abducens nerve palsy. Imaging demonstrated an expansile intraosseous mass originating in the upper clivus with extension superiorly into the sella turcica and laterally to involve the medial wall of the left cavernous sinus. The tumor was completely resected via an endoscopic endonasal approach, with postoperative improvement in lateral gaze palsy. Histopathology was consistent with chondroblastoma. Conclusion Chondroblastoma is a rare tumor of the craniofacial skeleton that should be included in the differential diagnosis of an osteolytic lesion of the clivus. Complete surgical resection remains the mainstay of treatment. PMID:26623238

  1. Conservative management of a pituitary tumor during pregnancy following induction of ovulation with gonadotropins.

    PubMed

    Jewelewicz, R; Zimmerman, E A; Carmel, P W

    1977-01-01

    Ovulation induced with human menopausal gonadotropin-human chorionic gonadotropin in a 27-year-old woman who had been amenorrheic for 7 years resulted in pregnancy. Although pretreatment neurologic evaluation was normal, significant loss of vision was found at 30 weeks' gestation, and a skull x-ray revealed enlargement and erosion of the sella turcica. As an attempt to delay surgery, 12 mg of dexamethasone daily arrested further visual deterioration, and the pregnancy continued uneventful for 36 weeks, when triplets were born. Five days after delivery the visual fields were normal. Trans-sphenoidal resection of a prolactin-secreting chromophobe adenoma of the pituitary was carried out 6 months later. It is suggested that when disturbance in visual perception due to a pituitary tumor occurs during pregnancy, a course of high-dose corticosteroids with frequent monitoring of visual fields and acuity might be tried before surgical intervention. Although further rapid deterioration in vision may dictate immediate surgical decompression, conservative management may result in stabilization, allowing the patient to carry the pregnancy to term and obviating the need for emergency surgery. PMID:832714

  2. Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism.

    PubMed

    Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon

    2016-02-01

    Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea. PMID:26981520

  3. GPS and Tide Gauge Constraints on Subsidence and Relative sea Level Rise Along the US East Coast

    NASA Astrophysics Data System (ADS)

    Jiang, Y.; Wdowinski, S.; Dixon, T. H.; Harrison, C. G.

    2007-12-01

    Relative sea level change has two distinct components, absolute sea level variation and movement of Earth's crust. The movement of the crust can sometimes bias estimation of absolute sea level change as inferred by tide gauge data. We employ high accuracy GPS measurements (Sella et al., 2007) to detect movement of the crust in eastern North America, primarily reflecting areas that are affected by Glacial Isostatic Adjustment (GIA). In particular, these data define the collapse of the "peripheral bulge". We compare the GPS data to relative sea level change as recorded by tide gauges. We use all tide gauge stations along the east coast of North America that have more than 60 years of data, and estimate the rate of relative sea level rise using a model that accounts for annual, semi-annual and decadal signals in the time series. The GPS data show regions with subsidence rate > 2mm/year between Virginia and South Carolina, ~1900--2500km away from the uplift center in Hudson Bay. Tide gauge data in these areas show about 4mm/year relative sea level rise. The inferred global sea level rise rate is about 2mm/year. Thus, land subsidence in these regions effectively doubles the relative sea level rise rate and the corresponding natural hazard.

  4. Endocrine and anatomical findings in a case of Solitary Median Maxillary Central Incisor Syndrome.

    PubMed

    Szakszon, Katalin; Felszeghy, Enikő; Csízy, István; Józsa, Tamás; Káposzta, Rita; Balogh, Erzsébet; Oláh, Eva; Balogh, István; Berényi, Ervin; Knegt, Alida C; Ilyés, István

    2012-02-01

    Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is a rare malformation syndrome consisting of multiple, mainly midline defects. Some authors suggest that it is a mild manifestation of the wide spectrum of holoprosencephaly, others classify it rather as a distinct entity. Authors report a case of SMMCI presenting with growth retardation, mild intellectual disability and absence of puberty. Cytogenetic and molecular cytogenetic investigations could identify no abnormalities. The presence of a single maxillary incisor called for further investigations to clarify hidden anomalies, these were empty sella, panhypopituitarism, hypothyroidism, and hypoplasia of the inner genitals. Based on the above findings, growth hormone, estrogen, and L-thyroxine substitution was introduced, which resulted in satisfactory longitudinal growth and onset of sexual maturation. We suggest genetic counselling and if needed, invasive investigations in female patients with short stature and absent/delayed puberty, with or without sex chromosomal anomalies, as the adequate therapy and even the quality of life of patient depends largely on the knowledge of their anatomical and endocrine status. PMID:22138217

  5. Upper Nasopharyngeal Corridor for Transnasal Endoscopic Drainage of Petroclival Cholesterol Granulomas: Alternative Access in Conchal Sphenoid Patients

    PubMed Central

    Turan, Nefize; Baum, Griffin R.; Holland, Christopher M.; Ahmad, Faiz U.; Henriquez, Oswaldo A.; Pradilla, Gustavo

    2015-01-01

    Background Cholesterol granulomas arising at the petrous apex can be treated via traditional open surgical, endoscopic, and endoscopic-assisted approaches. Endoscopic approaches require access to the sphenoid sinus, which is technically challenging in patients with conchal sphenoidal anatomy. Clinical Presentation A 55-year-old woman presented with intermittent headaches and tinnitus. Formal audiometry demonstrated moderately severe bilateral hearing loss. CT of the temporal bones and sella revealed a well-demarcated expansile lytic mass. MRI of the face, orbit, and neck showed a right petrous apex mass measuring 22 × 18 × 19 mm that was hyperintense on T1- and T2-weighted images without enhancement, consistent with a cholesterol granuloma. The patient had a conchal sphenoidal anatomy. Operative Technique Herein, we present an illustrative case of a low-lying petroclival cholesterol granuloma in a patient with conchal sphenoidal anatomy to describe an alternative high nasopharyngeal corridor for endoscopic transnasal transclival access. Postoperative Course Postoperatively, the patient's symptoms recovered and no complications occurred. Follow-up imaging demonstrated a patent drainage tract without evidence of recurrence. Conclusion In patients with a conchal sphenoid sinus, endoscopic transnasal transclival access can be gained using a high nasopharyngeal approach. This corridor facilitates safe access to these lesions and others in this location. PMID:26929897

  6. [Euclid and Pythagorus in the 21st century. A proposal on various harmonious craniofacial and occlusal constants].

    PubMed

    Blocquel, H

    2001-01-01

    The aim of this work was to study the architectural relationships between different squeletal and dental pieces participating in the mastication, and to prove their fixity. We have at our disposition a collection of teleradiographies taken from profile on the same subject, over the course of several years; 3000 of them have been selected. With the help of tracings, where are drawn 36 degrees angles; or 72 degrees and 108 degrees; we systematize our locations. Together with our ten experimenters, we have noticed the existence of a parallelism between the graphic representations of the Bouvet occlusal plane, the sphenoïdal planum (sphenoïdale bone) and the course of the second trigeminal branch (trigeminus nerve) in its infra-orbital section. The angle of those different marks with the superior clivus (quadrilateral strip of the sphenoïd) (dorsum sellae) still measures 72 degrees. It is equal to 108 degrees with the graphic representation of the third antero-inferior pterygoïd process. (pterygoïdeus process). The angle between the superior clivus and the pterygoïd process still measures 36 degrees. These works are new contributions to the orthodontic, occlusodontic or prosthetic conceptions. PMID:11799726

  7. Dual-Port 2D and 3D Endoscopy: Expanding the Limits of the Endonasal Approaches to Midline Skull Base Lesions with Lateral Extension

    PubMed Central

    Beer-Furlan, Andre; Evins, Alexander I.; Rigante, Luigi; Anichini, Giulio; Stieg, Philip E.; Bernardo, Antonio

    2014-01-01

    Objective To investigate a novel dual-port endonasal and subtemporal endoscopic approach targeting midline lesions with lateral extension beyond the intracavernous carotid artery anteriorly and the Dorello canal posteriorly. Methods Ten dual-port approaches were performed on five cadaveric heads. All specimens underwent an endoscopic endonasal approach from the sella to middle clivus. The endonasal port was combined with an anterior or posterior endoscopic extradural subtemporal approach. The anterior subtemporal port was placed directly above the middle third of the zygomatic arch, and the posterior port was placed at its posterior root. The extradural space was explored using two-dimensional and three-dimensional endoscopes. Results The anterior subtemporal port complemented the endonasal port with direct access to the Meckel cave, lateral sphenoid sinus, superior orbital fissure, and lateral and posterosuperior compartments of the cavernous sinus; the posterior subtemporal port enhanced access to the petrous apex. Endoscopic dissection and instrument maneuverability were feasible and performed without difficulty in both the anterior and posterior subtemporal ports. Conclusion The anterior and posterior subtemporal ports enhanced exposure and control of the region lateral to the carotid artery and Dorello canal. Dual-port neuroendoscopy is still minimally invasive yet dramatically increases surgical maneuverability while enhancing visualization and control of anatomical structures. PMID:25072012

  8. Imagining the absent dead: rituals of bereavement and the place of the war dead in German women's art during the First World War.

    PubMed

    Siebrecht, Claudia

    2011-01-01

    Drawing on women's visual responses to the First World War, this article examines female mourning in wartime Germany. The unprecedented death toll on the battlefronts, military burial practices and the physical distance from the remains of the war dead disrupted traditional rituals of bereavement, hindered closure and compounded women's grief on the home front. In response to these novel circumstances, a number of female artists used their images to reimagine funerary customs, overcome the separation from the fallen and express acute emotional distress. This article analyses three images produced during the conflict by the artists Katharina Heise, Martha Schrag and Sella Hasse, and places their work within the civilian experience of bereavement in war. By depicting the pain of loss, female artists contested the historical tradition of proud female mourning in German society and countered wartime codes of conduct that prohibited the public display of emotional pain in response to soldiers’ deaths. As a largely overlooked body of sources, women's art adds to our understanding of the tensions in wartime cultures of mourning that emerged between 1914 and 1918. PMID:21961193

  9. GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review.

    PubMed

    Tamura, Ryota; Takahashi, Satoshi; Emoto, Katsura; Nagashima, Hideaki; Toda, Masahiro; Yoshida, Kazunari

    2015-01-01

    Concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI) incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization. PMID:25883817

  10. Hunter syndrome in an 11-year old girl on enzyme replacement therapy with idursulfase: brain magnetic resonance imaging features and evolution.

    PubMed

    Manara, Renzo; Rampazzo, Angelica; Cananzi, Mara; Salviati, Leonardo; Mardari, Rodica; Drigo, Paola; Tomanin, Rosella; Gasparotto, Nicoletta; Priante, Elena; Scarpa, Maurizio

    2010-12-01

    Mucopolysaccharidosis type II (MPS-II, Hunter disease) is a X-linked recessive disorder. Affected females are extremely rare, mostly due to skewed X chromosome inactivation. A few papers outline MPS-II brain magnetic resonance imaging (MRI) "gestalt" in males, but neuroradiological reports on females are still lacking. We present an 11-year-old girl affected by the severe form of MPS-II who was followed up over a time span of 8 years, focusing on clinical and brain MRI evolution. In the last 2.5 years, the patient has been treated with enzyme replacement therapy (ERT) with idursulfase (Elaprase™, Shire Human Genetic Therapies AB, Sweden). On brain and cervical MRI examination, abnormalities in our patient did not differ from those detected in male patients: J-shaped pituitary sella, enlargement of perivascular spaces, brain atrophy, mild T2-hyperintensity in the paratrigonal white matter, diffuse platyspondylia, and mild odontoid dysplasia with odontoid cup. Brain atrophy progressed despite ERT introduction, whereas perivascular space enlargement did not change significantly before and after ERT. Cognitive impairment worsened independently from the course of white matter abnormality. Despite a profound knowledge of genetic and biochemical aspects in MPS-II, neuroradiology is still poorly characterized, especially in female patients. Spinal and brain involvement and its natural course and evolution after ERT introduction still need to be clarified. PMID:20052546

  11. Metric analysis of basal sphenoid angle in adult human skulls

    PubMed Central

    Netto, Dante Simionato; Nascimento, Sergio Ricardo Rios; Ruiz, Cristiane Regina

    2014-01-01

    Objective To analyze the variations in the angle basal sphenoid skulls of adult humans and their relationship to sex, age, ethnicity and cranial index. Methods The angles were measured in 160 skulls belonging to the Museum of the Universidade Federal de São Paulo Department of Morphology. We use two flexible rules and a goniometer, having as reference points for the first rule the posterior end of the ethmoidal crest and dorsum of the sella turcica, and for the second rule the anterior margin of the foramen magnum and clivus, measuring the angle at the intersection of two. Results The average angle was 115.41°, with no statistical correlation between the value of the angle and sex or age. A statistical correlation was noted between the value of the angle and ethnicity, and between the angle and the horizontal cranial index. Conclusions The distribution of the angle basal sphenoid was the same in sex, and there was correlation between the angle and ethnicity, being the proportion of non-white individuals with an angle >125° significantly higher than that of whites with an angle >125°. There was correlation between the angle and the cranial index, because skulls with higher cranial index tend to have higher basiesfenoidal angle too. PMID:25295452

  12. Upper Nasopharyngeal Corridor for Transnasal Endoscopic Drainage of Petroclival Cholesterol Granulomas: Alternative Access in Conchal Sphenoid Patients.

    PubMed

    Turan, Nefize; Baum, Griffin R; Holland, Christopher M; Ahmad, Faiz U; Henriquez, Oswaldo A; Pradilla, Gustavo

    2016-03-01

    Background Cholesterol granulomas arising at the petrous apex can be treated via traditional open surgical, endoscopic, and endoscopic-assisted approaches. Endoscopic approaches require access to the sphenoid sinus, which is technically challenging in patients with conchal sphenoidal anatomy. Clinical Presentation A 55-year-old woman presented with intermittent headaches and tinnitus. Formal audiometry demonstrated moderately severe bilateral hearing loss. CT of the temporal bones and sella revealed a well-demarcated expansile lytic mass. MRI of the face, orbit, and neck showed a right petrous apex mass measuring 22 × 18 × 19 mm that was hyperintense on T1- and T2-weighted images without enhancement, consistent with a cholesterol granuloma. The patient had a conchal sphenoidal anatomy. Operative Technique Herein, we present an illustrative case of a low-lying petroclival cholesterol granuloma in a patient with conchal sphenoidal anatomy to describe an alternative high nasopharyngeal corridor for endoscopic transnasal transclival access. Postoperative Course Postoperatively, the patient's symptoms recovered and no complications occurred. Follow-up imaging demonstrated a patent drainage tract without evidence of recurrence. Conclusion In patients with a conchal sphenoid sinus, endoscopic transnasal transclival access can be gained using a high nasopharyngeal approach. This corridor facilitates safe access to these lesions and others in this location. PMID:26929897

  13. Pituitary metastases from the oncocytic variant of follicular thyroid carcinoma: a case report and diagnostic dilemmas.

    PubMed

    Matyja, Ewa; Zieliński, Grzegorz; Witek, Przemysław; Kamiński, Grzegorz; Grajkowska, Wiesława; Maksymowicz, Maria

    2013-01-01

    Metastases to the pituitary gland and sella turcica are uncommon. The distinction between primary and secondary metastatic pituitary tumours is challenging as carcinomas from distant sites might closely resemble, both clinically and histopathologically, non-functional adenomas or primary pituitary carcinomas. Among metastases to pituitary gland ones from thyroid carcinoma are extremely rare. We present a unique case of a 53-year-old male patient with a past history of thyroid carcinoma who underwent repeated surgeries over a period of 7 years for a sellar-parasellar mass with paranasal sinus involvement. Morphologically, the tumour was composed of solid sheaths of monomorphic cells exhibiting oncocytic features. In electron microscope images, the cytoplasm of tumour cells was filled with numerous mitochondria. The tumour was negative for pituitary hormones but exhibited immunoreactivity for cytokeratin AE1/AE3, thyroglobulin and thyroid transcription factor 1 (TTF-1). Based on the clinical data and immunophenotypic profile, the tumour was finally diagnosed as an oncocytic variant of follicular thyroid carcinoma. To our knowledge, this is probably the first report of such peculiar histopathological variant of follicular thyroid carcinoma metastasizing to the pituitary gland. The diagnostic dilemmas considering oncocytic features of the presented case are discussed. PMID:24114644

  14. Adult multisystem langerhans cell histiocytosis presenting with central diabetes insipidus successfully treated with chemotherapy.

    PubMed

    Choi, Jung-Eun; Lee, Hae Ri; Ohn, Jung Hun; Moon, Min Kyong; Park, Juri; Lee, Seong Jin; Choi, Moon-Gi; Yoo, Hyung Joon; Kim, Jung Han; Hong, Eun-Gyoung

    2014-09-01

    We report the rare case of an adult who was diagnosed with recurrent multisystem Langerhans cell histiocytosis (LCH) involving the pituitary stalk and lung who present with central diabetes insipidus and was successfully treated with systemic steroids and chemotherapy. A 49-year-old man visited our hospital due to symptoms of polydipsia and polyuria that started 1 month prior. Two years prior to presentation, he underwent excision of right 6th and 7th rib lesions for the osteolytic lesion and chest pain, which were later confirmed to be LCH on pathology. After admission, the water deprivation test was done and the result indicated that he had central diabetes insipidus. Sella magnetic resonance imaging showed a mass on the pituitary stalk with loss of normal bright spot at the posterior lobe of the pituitary. Multiple patchy infiltrations were detected in both lung fields by computed tomography (CT). He was diagnosed with recurrent LCH and was subsequently treated with inhaled desmopressin, systemic steroids, vinblastine, and mercaptopurine. The pituitary mass disappeared after two months and both lungs were clear on chest CT after 11 months. Although clinical remission in multisystem LCH in adults is reportedly rare, our case of adult-onset multisystem LCH was treated successfully with systemic chemotherapy using prednisolone, vinblastine, and 6-mercaptopurine, which was well tolerated. PMID:25309800

  15. Adult Multisystem Langerhans Cell Histiocytosis Presenting with Central Diabetes Insipidus Successfully Treated with Chemotherapy

    PubMed Central

    Choi, Jung-Eun; Lee, Hae Ri; Ohn, Jung Hun; Moon, Min Kyong; Park, Juri; Lee, Seong Jin; Choi, Moon-Gi; Yoo, Hyung Joon; Kim, Jung Han

    2014-01-01

    We report the rare case of an adult who was diagnosed with recurrent multisystem Langerhans cell histiocytosis (LCH) involving the pituitary stalk and lung who present with central diabetes insipidus and was successfully treated with systemic steroids and chemotherapy. A 49-year-old man visited our hospital due to symptoms of polydipsia and polyuria that started 1 month prior. Two years prior to presentation, he underwent excision of right 6th and 7th rib lesions for the osteolytic lesion and chest pain, which were later confirmed to be LCH on pathology. After admission, the water deprivation test was done and the result indicated that he had central diabetes insipidus. Sella magnetic resonance imaging showed a mass on the pituitary stalk with loss of normal bright spot at the posterior lobe of the pituitary. Multiple patchy infiltrations were detected in both lung fields by computed tomography (CT). He was diagnosed with recurrent LCH and was subsequently treated with inhaled desmopressin, systemic steroids, vinblastine, and mercaptopurine. The pituitary mass disappeared after two months and both lungs were clear on chest CT after 11 months. Although clinical remission in multisystem LCH in adults is reportedly rare, our case of adult-onset multisystem LCH was treated successfully with systemic chemotherapy using prednisolone, vinblastine, and 6-mercaptopurine, which was well tolerated. PMID:25309800

  16. [Gross tumor volume (GTV) and clinical target volume (CTV) in radiotherapy of benign skull base tumors].

    PubMed

    Maire, J P; Liguoro, D; San Galli, F

    2001-10-01

    Skull base tumours represent about 35 to 40% of all intracranial tumours. There are now many reports in the literature confirming the fact that about 80 to 90% of such tumours are controlled with fractionated radiotherapy. Stereotactic and 3-dimensional treatment planning techniques increase local control and central nervous system tolerance. Definition of the gross tumor volume (GTV) is generally easy with currently available medical imaging systems and computers for 3-dimensional dosimetry. The definition of the clinical target volume (CTV) is more difficult to appreciate; it is defined from the CTV plus a margin, which depends on the histology and anterior therapeutic history of the tumour. It is important to take into account the visible tumour and its possible extension pathways (adjacent bone, holes at the base of skull) and/or an anatomic region (sella turcica + adjacent cavernous sinus). It is necessary to evaluate these volumes with CT Scan and MRI to appreciate tumor extension in a 3-dimentional approach, in order to reduce the risk of marginal recurrences. The aim of this paper is to discuss volume definition as a function of tumour site and tumour type to be irradiated. PMID:11715310

  17. Hyperprolactinemia Secondary to Allergic Fungal Sinusitis Compressing the Pituitary Gland.

    PubMed

    Chapurin, Nikita; Wang, Cynthia; Steinberg, David M; Jang, David W

    2016-01-01

    Objective. We aim to describe the first case in the literature of allergic fungal sinusitis (AFS) presenting with hyperprolactinemia due to compression of the pituitary gland. Case Presentation. A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. Workup revealed elevated prolactin of 94.4, negative pregnancy test, and normal thyroid function. MRI and CT demonstrated a 5.0 × 2.7 × 2.5 cm heterogeneous expansile mass in the right sphenoid sinus with no pituitary adenoma as originally suspected. Patient was placed on cabergoline for symptomatic control until definitive treatment. Results. The patient underwent right endoscopic sphenoidotomy, which revealed nasal polyps and fungal debris in the sphenoid sinus, consistent with AFS. There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with allergic fungal sinusitis caused by Curvularia species. Prolactin levels normalized four weeks after surgery with resolution of symptoms. Conclusion. Functional endoscopic sinus surgery alone was able to reverse the patient's pituitary dysfunction. To our knowledge, this is the first case of AFS presenting as hyperprolactinemia due to pituitary compression. PMID:26998375

  18. [An autopsied case of pachymeningitis associated with a ruptured, cerebral aneurysm due to Aspergillus infection].

    PubMed

    Nonaka, N; Yamazaki, M; Onishi, Y; Shibuya, H; Okazaki, E

    2001-10-01

    We reported a 64-years-old woman with pachymeningitis associated with a ruptured mycotic cerebral aneurysm due to Aspergillus infection. She had suffered from diabetes mellitus and been treated since she was 49 years old. She complained of headache at the age of 62 and loss of her left visual acuity three months later. She was treated by the pulse therapy of methylprednisolone as neuritis retrobulbaris and her visual acuity recovered. But her headache continued. Three months later, her right visual acuity was lost, and the pulse therapy was not effective this time. Six months later, she died of subarachnoid hemorrhage following acute meningitis. The autopsy was granted, but limited to the cranial cavity. Macroscopically, it disclosed brownish thickened dura around sella turucica involving trigeminal ganglion and optic nerve, and fresh subarachnoid hemorrhage in the basal cisterns and a ruptured aneurysm (3 mm in diameter) between internal carotid and posterior cerebral artery on the left side. Histologically, the brownish thickened dura was infiltrated by lymphocytes, plasma cells, and multinucleated giant cells. The wall around the aneurysm was infiltrated by lymphocytes and plasma cells as well as many fungi. Immunohistochemistry demonstrated the presence of Aspergillus in the thickened dura and the arterial wall around the aneurysm. There were lymphocytes and plasma cell infiltration in the basal subarachnoid space and scattered microabcesses in the brain. Although the first entry of Aspergillus to the dura was unclear, we assume that the final intravascular dissemination of Aspergillus from the dura caused meningitis and mycotic aneurysm. PMID:11993187

  19. Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management.

    PubMed

    Amlashi, Fatemeh G; Tritos, Nicholas A

    2016-06-01

    Inappropriate secretion of TSH was first described in 1960 in a patient with evidence of hyperthyroidism and expanded sella on imaging. It was later found that a type of pituitary adenoma that secretes TSH (thyrotropinoma) was the underlying cause. The objective of the present review article is to summarize data on the epidemiology, pathogenesis, diagnosis, and management of thyrotropinomas. The prevalence of thyrotropinomas is lower than that of other pituitary adenomas. Early diagnosis is now possible thanks to the availability of magnetic resonance imaging and sensitive laboratory assays. As a corollary, many patients now present earlier in the course of their disease and have smaller tumors at the time of diagnosis. Treatment also has evolved over time. Transsphenoidal surgery is still considered definitive therapy. Meanwhile, radiation therapy, including radiosurgery, is effective in achieving tumor control in the majority of patients. In the past, radiation therapy was used as second line treatment in patients with residual or recurrent tumor after surgery. However, the availability of somatostatin analogs, which can lead to normalization of thyroid function as well as shrink these tumors, has led to an increase in the role of medical therapy in patients who are not in remission after pituitary surgery. In addition, dopamine agonists have shown some efficacy in the management of these tumors. Better understanding of the molecular pathogenesis of thyrotropinomas may lead to rationally designed therapies for patients with thyrotropinomas. PMID:26792794

  20. Glacial isostatic adjustment using GNSS permanent stations and GIA modelling tools

    NASA Astrophysics Data System (ADS)

    Kollo, Karin; Spada, Giorgio; Vermeer, Martin

    2013-04-01

    Glacial Isostatic Adjustment (GIA) affects the Earth's mantle in areas which were once ice covered and the process is still ongoing. In this contribution we focus on GIA processes in Fennoscandian and North American uplift regions. In this contribution we use horizontal and vertical uplift rates from Global Navigation Satellite System (GNSS) permanent stations. For Fennoscandia the BIFROST dataset (Lidberg, 2010) and North America the dataset from Sella, 2007 were used respectively. We perform GIA modelling with the SELEN program (Spada and Stocchi, 2007) and we vary ice model parameters in space in order to find ice model which suits best with uplift values obtained from GNSS time series analysis. In the GIA modelling, the ice models ICE-5G (Peltier, 2004) and the ice model denoted as ANU05 ((Fleming and Lambeck, 2004) and references therein) were used. As reference, the velocity field from GNSS permanent station time series was used for both target areas. Firstly the sensitivity to the harmonic degree was tested in order to reduce the computation time. In the test, nominal viscosity values and pre-defined lithosphere thicknesses models were used, varying maximum harmonic degree values. Main criteria for choosing the suitable harmonic degree was chi-square fit - if the error measure does not differ more than 10%, then one might use as well lower harmonic degree value. From this test, maximum harmonic degree of 72 was chosen to perform calculations, as the larger value did not significantly modify the results obtained, as well the computational time for observations was kept reasonable. Secondly the GIA computations were performed to find the model, which could fit with highest probability to the GNSS-based velocity field in the target areas. In order to find best fitting Earth viscosity parameters, different viscosity profiles for the Earth models were tested and their impact on horizontal and vertical velocity rates from GIA modelling was studied. For every

  1. Evaluation of soft and hard tissue changes after bimaxillary surgery in class III orthognathic surgery and aesthetic consideration

    PubMed Central

    Ghassemi, Mehrangiz; Ghassemi, Alireza; Showkatbakhsh, Rahman; Ahmad, Syed Sayeed; Shadab, Mohammad; Modabber, Ali; Jamilian, Abdolreza

    2014-01-01

    Aims: The aim of this study was to evaluate hard and soft tissue change after bimaxillary surgery in class III patients by focusing on sella, nasion, A point (SNA) and sella, nasion, B point (SNB) angle and aesthetic outcome. Materials and Methods: The sample consisted of 96 skeletal Class III patients (42 women, 54 men) with a mean age of 25 years with standard deviation (SD) of 8.4. The youngest patient was 16-years-old and the oldest 51-years-old at the time of surgery. In total, seven skeletal parameters, eight soft tissue parameters, and two dental parameters were evaluated on the cephalograms. Result: At the beginning of the treatment 49 Patients had SNA between 80° and 84°, 34 had SNA of less than 80° and 13 had SNA of more than 84°. Post surgically, 25 patients had SNA of 78°–84°, 19 had SNA less than 78° and 52 patients had SNA of more than 84°. Out of 96 patients 22 had SNB of 78°–82° before surgery, 16 had less than 78° and 58 had SNA of more than 84°. Postoperatively, we measured SNB of 78°–80° in 42, less than 78° in 18 and of more than 82° in 36 patients. The inclination of the maxilla relative to the cranial base changed from 7.2° (SD = 4)–8° (SD = 5.1) and the mandible changed from 35.7° (SD = 6.6) to 36° (SD = 6.3) postoperatively which was not significant. The distance from upper lip to E-line increased by 2.6 mm (SD = 3.9) after surgery (P < 0.001), while, the lower lip distance to E-line decreased slightly by 0.9 mm (SD = 3.2) (P < 0.01). Nasolabial angle was decreased by 9.5° (SD = 9.4) after surgery (P < 0.001). The nose prominence also decreased from 18.2 mm (SD = 3.5) –16.5 mm (SD = 3.3). Conclusion: Although in many cases we did not have a SNA angle or SNB angle in normal range but a good aesthetic outcome have been observed. Consequently our study showed that soft tissue change and aesthetic aspects should be considered in surgical planning and achieving SNA angle or SNB angle of norm range should not be the

  2. [Visual field defects in hydrocephalus].

    PubMed

    Kojima, N; Tamaki, N; Hosoda, K; Matsumoto, S

    1985-03-01

    Eight patients representing visual field defects associated with hydrocephalus are reviewed. Seven cases had aqueductal stenosis and one had congenital communicating hydrocephalus. We found five cases of defects in visual field typical of a chiasmal or optic nerve lesion: (1) inferior altitudinal hemianopia with inferior nasal quadrantanopia in the opposite eye; (2) inferior binasal quadrantanopia; (3) unilateral inferior nasal depression; (4) unilateral temporal defect; (5) bilateral central scotoma. In these cases CT demonstrated moderate or marked symmetrical dilatation of the third and lateral ventricles. Four out of five cases showed bulging of the third ventricle anteriorly into the sella turcica on CT or ventriculography. Other three patients had incongruous homonymous hemianopia. Characteristic asymmetrical dilatation of the lateral ventricles was noted in all three cases. The more enlarged lateral ventricles were ipsilateral with the affected visual pathways. The sites of lesion responsible for these field defects seemed to be optic tract in one case and optic radiation in two cases. Ventriculoperitoneal shunt was placed in five out of seven cases. Impaired visual field improved in three patients after shunt insertion. A 28-year-old female who had history of blurred vision fos 14 days showed improvement in visual acuity and field when the enlarged ventricles became slit-like by shunting. In the other two patients defects in visual fields improved in spite of consistent ventriculomegaly. These facts suggested that not only the mechanical forces with distended third ventricle but also increased intracranial pressure played an important role in producing visual field defects in hydrocephalic patients. PMID:3874634

  3. Cerebral neuroblastoma and pituitary adenocarcinoma in two budgerigars (Melopsittacus undulatus).

    PubMed

    Dezfoulian, O; Abbasi, M; Azarabad, H; Nouri, M; Kiani, K

    2011-12-01

    Case 1: A tumor mass involving the rostral part of left cerebrum was found in a two-year-old female budgerigar (Melopsittacus undulatus) at necropsy. Histologically, the neoplastic cells were arranged in sheets or cords and occasionally showed nest growth patterns. These uniform tumor cells had a little cytoplasm and ovoid or round basophilic nuclei with clearly distinct cytoplasmic membranes. The tumor cells were strong diffusely immunostained with both neuron-specific enolase (NSE) and neurofilament protein and partially for synaptophysin. They lacked chromogranin A, glial fibrillary acidic protein (GFAP), vimentin, S-100, and cytokeratin antigen expression. Moreover, they had no reaction to antibodies against pituitary hormones, such as adrenocorticotrophic hormone (ACTH), growth hormone, and prolactin. The histological and immunohistochemical examination determined the tumor as neuroblastoma. Case 2: An extremely enlarged pituitary mass was found above the sella turcica of a male budgerigar. It was soft and well delineated from the adjacent structures. On histological examination, this tumor consisted of a sheet of large closely packed polyhedral cells that had scant to a large amount of pale to strongly eosinophilic cytoplasm. The pleomorphic nuclei were apparently variable in shape, from small round hyperchromatic to very large vesicular forms. The cell boundaries were not clearly distinct. The multifocal immunolabelling of neoplastic cells for NSE, synaptophysin, GFAP, and ACTH appeared, whereas a few cells reacted with vimentin and S-100 and stained negative for other markers, which were also utilized for case 1. Histological and immunohistochemical findings led to identification of corticotroph adenocarcinoma in the pituitary gland. PMID:22312997

  4. Morphological likeness of the skeletal remains in a Central European family from 17th to 19th century.

    PubMed

    Veleminský, P; Dobisíková, M

    2005-01-01

    In spite of a recent preferential application of molecular genetic methods to kinship determination of anonymous human skeletal remains, the classical anthropological methods cannot be rejected as they are simple, quick and give access to a large part of a genome. This paper deals with the extent of morphological skeletal similarity in persons of known genealogical relationship. The skeletal remains of eight individuals from the family tomb of the Swéerts-Sporck's noble family in castle Kuks, East Bohemia, Czech Republic were analysed. Basic personal details, as well as data on their genealogical relationship, were available. Individuals were compared according to 173 anatomical variants--epigenetic traits, 90 of which were located on the skull and 83 on the postcranial skeleton. For each trait the percentile coincidence and/or difference were calculated. We observed the highest coincidence between the father and his son. These two individuals showed both closest correlation in the presence and the least difference in the occurrence of anatomical variants, as well as a high value of paternal probability. Clear kinship was also detected among cousins of the same or opposite sex. However, kinship between brother and sister was not so evident. The greatest difference was observed amongst biologically unrelated family members such as women who married into the family. The individuals under investigation showed a significantly higher occurrence of three among four traits of the sella turcica (ponticulus carotico-clinoideus, ponticulus interclinoideus, taenia interclinoidea; 99% confidence). A significantly higher occurrence of the ponticuli basales ossis sphenoidalis, palatine torus and the costal articular surface on the body of 7th cervical vertebrae was also found (95% confidence). Our results, therefore, suggest that these morphological variants might be considered as family-specific traits. PMID:16130840

  5. Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck

    SciTech Connect

    Samaan, N.A.; Vieto, R.; Schultz, P.N.; Maor, M.; Meoz, R.T.; Sampiere, V.A.; Cangir, A.; Ried, H.L.; Jesse, R.H. Jr.

    1982-11-01

    One hundred-ten patients who had nasopharyngeal cancer and paranasal sinus tumors and were free of the primary disease were studied one to 26 years following radiotherapy. There were 70 males and 40 females ranging in age from 4 to 75 years, with a mean age of 36.5 years. During therapy both the hypothalamus and the anterior pituitary gland were in the field of irradiation. The radiation dose to the hypothalamus and the anterior pituitary gland was estimated to be 400 to 7500 rad with a median dose of 5618 rad to the anterior pituitary gland and a median dose of 5000 rad to the hypothalamus. We found evidence of endocrine deficiencies in 91 of the 110 patients studied. Seventy-six patients showed evidence of one or more hypothalamic lesions and 43 patients showed evidence of primary pituitary deficiency. Forty of the 66 patients who received radiotherapy to the neck for treatment or prevention of lymph node metastasis showed evidence of primary hypothyroidism. The range of the dose to the thyroid area was 3000 to 8800 rad with a median of 5000 rad. One young adult woman who developed galactorrhea and amenorrhea 2 years following radiotherapy showed a high serum prolactin level, but had normal anterior pituitary function and sella turcica. She regained her menses and had a normal pregnancy and delivery following bromocriptine therapy. These results indicate that endocrine deficiencies after radiotherapy for tumors of the head and neck are common and should be detected early and treated. Long-term follow-up of these patients is indicated since complications may appear after the completion of radiotherapy.

  6. [Hyperthyroidism caused by a TSH producing pituitary adenoma].

    PubMed

    Prasch, F; Knosp, S E; Steinbach, R; Wogritsch, S; Hurtl, I; Greifeneder, M; Holm, C; Najemnik, C; Dudczak, R

    1999-01-01

    Elevated levels of free triiodothyronine (fT3) of 8.8 ng/dl (normal range 2.0 to 4.2) and free thyroxin (fT4) of 3.5 pg/ml (0.8 to 1.7) were found in the course of an examination of a 53-year old patient due to a planned hysterectomy. As thyrotropin (TSH) also was elevated with 5.8 mU/l (0.4 to 4.5), these findings corresponded to an inappropriate secretion of TSH (IST). Additional examinations revealed a blunted rise of TSH secretion after i.v. injection of 200 micrograms thyrotropin releasing hormone (TRH) as well as lacking suppression of TSH secretion after oral doses of 75 micrograms T3 during one week. alpha-TSH levels with 3.7 micrograms/l were elevated in comparison to a matched normal sample just as the molar ratio alpha-TSH/TSH with 6.95 and sex hormone-binding globulin (SHBG) with 175 nmol/l and showed an absence of inhibition in the T3 suppression test. These results were suggestive of neoplastic inappropriate secretion of TSH (nIST) due to a TSH-secreting pituitary adenoma. In concordance, the magnetic resonance imaging (MRI) showed a 1 cm tumor in the sella. The adenoma could also be visualized by 111In-octreotide and 123I-epidepride scintigraphies of the pituitary gland. After transsphenoidal resection, histological examination of the tumor resulted in the finding of a TSH-secreting adenoma. Postoperative TSH levels were not detectable, indicating the complete removal of the adenoma. Levels of fT3 and fT4 were slightly below normal with 1.9 pg/ml and 0.7 ng/dl, respectively. A control scintigraphy with 111In-octreotide following an equivocal MRI showed no uptake in the pituitary. PMID:10230475

  7. [Suprasellar arachnoid cyst--report of a case (author's transl)].

    PubMed

    Takahashi, T; Kawai, S; Kaminoh, T; Hiramatsu, K; Maekawa, M; Yuasa, T; Miyamoto, N; Hattori, Y

    1982-04-01

    A 4-year-old boy with suprasellar arachnoid cyst was reported. At the age of 30-month-old his aunt was aware of his squint. During the observation by ophthalmologists from the age of 1y. to 3y., enlargement of the head and impairment of the visual acuity were manifested. Cranial CT scan revealed the enlargement of the ventricular system and a round low density area located superior to the sella. Absorption coefficient of the lesion was similar to that of the cerebrospinal fluid. No abnormal contrast enhancement was seen. Examination revealed the head circumference of 53.3 cm larger than doubled standard deviation, the right external strabismus, impaired vision (R:0.03, L:0.3) and optic atrophy but no other neurological signs. Cerebral angiography showed suprasellar mass lesion. After the ventriculography with water-soluble contrast medium, V-P shunt operation was performed and then the patient was transferred to the CT room. CSF enhanced CT scan showed no communication between the ventricles and the cyst. By frontotemporal approach, microsurgical removal of the cystwall was performed and the histological diagnosis was arachnoid membrane. Several days after the operation, bilateral subdural effusion was seen on CT scan and was treated with bilateral S-P shunt and the removal of V-P shunt. Follow up CT scan disclosed the disappearance of the subdural effusion and the suprasellar cyst. The visual acuity was improved well and the endocrinological study was normal. Analysis of the 45 reported cases of suprasellar arachnoid cyst suggested that direct removal of the cyst wall is better than the V-P shunt operation and the cyst shunting is advisable for repeat recurrence of the cyst. Removal of the ventricular shunting system may be effective for the prevention of the subdural effusion as a complication after direct operation. PMID:7099383

  8. Skeletal Stability after Bilateral Sagittal Split Advancement and Setback Osteotomy of the Mandible with Miniplate Fixation

    PubMed Central

    Rao, Srinivasan Hanumantha; Selvaraj, Loganathan; Lankupalli, Arathy S.

    2013-01-01

    The purpose of this study was to evaluate intraorally placed mini plates and monocortical screws in terms of postoperative skeletal stability after bilateral sagittal split advancement and setback osteotomy of the mandible. Ten patients were included in this study with five requiring advancement (group I) and five requiring setback of the mandible (group II). Bell and Epker modified surgical technique was followed for all the patients. All the patients underwent pre- and postsurgical orthodontics. Cephalometric radiographs were taken preoperatively, immediate, 3, 6, and 12 months postoperatively. Cephalometric tracings were performed by one individual examiner using a modified burstone analysis. Statistical analysis was performed using the student paired t-test. In advancement patients, SNB (sella, Nasion, B point) angle showed relapse at 12th month postoperative period which was statistically significant (2.4 degrees). No changes were observed in anterior facial height, posterior facial height, Frankfort-mandibular incisor angle (FmiA), and overjet during the follow-up period. In setback patients, posterior facial height (p < 0.05), angles between the lower incisors and mandibular plane and pogonion had a statistically significant change position of 1.4 mm (paired t-test, p = 0.03). The SNB angle, anterior facial height, interincisal angle, and FmiA remained constant (0.8–1.2 degrees) during the follow-up period. In advancement cases, the relapse was seen from the third month postoperative period but in setback cases, the relapse was noted from the sixth month onward and the skeletal relapse in these cases were noticed cephalometrically. PMID:24624252

  9. Direct Invasion of the Optic Nerves, Chiasm, and Tracts by Cryptococcus neoformans in an Immunocompetent Host.

    PubMed

    Merkler, Alexander E; Gaines, Nathan; Baradaran, Hediyeh; Schuetz, Audrey N; Lavi, Ehud; Simpson, Sara A; Dinkin, Marc J

    2015-10-01

    Cryptococcus spp is a common fungal infection and frequent cause of meningitis in immunocompromised patients; however, immunocompetent patients are also at risk of infection. Visual loss often occurs via elevated intracranial hypertension but can rarely occur through direct optic nerve, chiasm, or tract invasion. We report a case of a 38-year-old woman who presented with decreased acuity in both eyes. She had generalized visual field constriction in the right eye and temporal hemianopsia in the left eye. Magnetic resonance imaging of the brain and orbits showed multiple areas of ill-defined enhancement in the optic chiasm and tracts as well as in the diaphragmatic sella, prepontine and interpeduncular cisterns, and along cranial nerves VI, VII, and VIII bilaterally. Initial cerebrospinal fluid (CSF) showed 34 white blood cells, hypoglycorrhachia, and negative cryptococcal antigen and bacterial and fungal cultures. A transphenoidal biopsy of the dura and pituitary gland was unremarkable. Empiric steroids resulted in marked improvement in visual acuity in both eyes, but while tapering steroids, she developed rapid visual loss bilaterally. Repeat CSF performed 6 weeks later demonstrated a cryptococcal antigen titer of 1:512. Retroactive staining of the pituitary biopsy was positive for mucicarmine, a component of the polysaccharide capsule of Cryptococcus spp. After induction therapy with amphotericin B and flucytosine and 1 year of fluconazole, her visual acuity was 20/20 in both eyes. In summary, Cryptococcus can affect immunocompetent patients and often presents with insidious, chronic meningitis. Visual loss is common in cryptococcal meningitis but usually results from fulminant papilledema related to elevated intracranial pressure. In rare cases, direct nerve or chiasm infiltration by the fungus results in vision loss. PMID:26425249

  10. Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma

    PubMed Central

    Peng, Zesheng; Tian, Daofeng; Wang, Hongliu; Kong, Derek Kai; Zhang, Shenqi; Liu, Baohui; Deng, Gang; Xu, Zhou; Wu, Liquan; Ji, Baowei; Wang, Long; Cai, Qiang; Li, Mingchang; Wang, Junmin; Zhang, Aimin; Chen, Qianxue

    2015-01-01

    Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients. PMID:26823732

  11. Primary Spontaneous Cerebrospinal Fluid Leaks and Idiopathic Intracranial Hypertension

    PubMed Central

    Pérez, Mario A.; Bialer, Omer Y.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie

    2014-01-01

    Introduction Idiopathic intracranial hypertension (IIH) is increasingly recognized as a cause of spontaneous cerebrospinal (CSF) leak in the ENT and neurosurgical literature. The diagnosis of IIH in patients with spontaneous CSF leaks is classically made a few weeks after surgical repair of the CSF leak when symptoms and signs of elevated intracranial pressure (ICP) appear. Methods Case reports and literature review. Two young obese women developed spontaneous CSF rhinorrhea related to an empty sella in one, and a cribriform plate encephalocele in the other. Both patients underwent surgical repair of the CSF leak. A few weeks later, they developed chronic headaches and bilateral papilledema. Lumbar punctures showed elevated CSF-opening pressures with normal CSF contents, with temporary improvement of headaches. A man with a three-year history of untreated IIH developed spontaneous CSF rhinorrhea. He experienced improvement of his headaches and papilledema after a CSF shunting procedure, and the rhinorrhea resolved after endoscopic repair of the leak. Results These cases and the literature review confirm a definite association between IIH and spontaneous CSF leak based on: 1) similar demographics; 2) increased ICP in some patients with spontaneous CSF leak after leak repair; 3) higher rate of leak recurrence in patients with raised ICP; 4) patients with intracranial hypertension secondary to tumors may develop CSF leak, confirming that raised ICP from other causes than IIH can cause CSF leak. Conclusions CSF leak may occasionally keep IIH patients symptom-free; however, classic symptoms and signs of intracranial hypertension may develop after the CSF leak is repaired, exposing these patients to a high risk of recurrence of the leak unless an ICP-lowering intervention is performed. PMID:24042170

  12. Orthopedic correction of growing hyperdivergent, retrognathic patients with miniscrew implants.

    PubMed

    Buschang, Peter H; Carrillo, Roberto; Rossouw, P Emile

    2011-03-01

    Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do address them require long-term patient compliance. This article introduces a novel approach using miniscrew implants (MSIs) and growth to treat retrognathic, hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (aged 13.2 ± 1.1 years) and again at the end of the orthopedic phase (after 1.9 ± 0.3 years). Each patient had 2 MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a rapid palatal expander, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Before treatment, the patients exhibited substantial and significant mandibular retrusion (Z score = -1.0), facial convexity (Z score = 0.7), and hyperdivergence (Z score = 1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced by a mean of 2.4 mm, the sella-nasion-basion (SNB) angle increased by 2.1°, the mandibular plane angle decreased by 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individual's growth potential. PMID:21236539

  13. Central nervous system imaging in childhood Langerhans cell histiocytosis – a reference center analysis

    PubMed Central

    Porto, Luciana; Schöning, Stefan; Hattingen, Elke; Sörensen, Jan; Jurcoane, Alina; Lehrnbecher, Thomas

    2015-01-01

    Background The aim of our study was (1) to describe central nervous system (CNS) manifestations in children with Langerhans cell histiocytosis (LCH) based on images sent to a reference center and meeting minimum requirements and (2) to assess the inter-rater agreement of CNS-MRI results, which represents the overall reproducibility of this investigation. Methods We retrospectively reviewed brain MRI examinations in children with LCH, for which MRI minimum requirements were met. Abnormalities were rated by two experienced neuroradiologists, and the inter-rater agreement was assessed. Results Out of a total of 94 imaging studies, only 31 MRIs met the minimum criteria, which included T2w, FLAIR, T1w images before/after contrast in at least two different section planes, and thin post contrast sagittal slices T1w through the sella. The most common changes were osseous abnormalities, followed by solid enlargement of the pineal gland, thickened enhancing stalk and signal changes of the dentate nucleus. Whereas inter-rater agreement in assessing most of the CNS lesions was relatively high (κ > 0.61), the application of minimum criteria often did not allow to evaluate the posterior pituitary. Conclusions The diversity of radiological protocols from different institutions leads to difficulties in the diagnosis of CNS abnormalities in children with LCH. Although the inter-rater agreement between neuroradiologists was high, not all the LCH manifestations could be completely ruled out when using the minimum criteria. Brain MRIs should therefore follow LCH guideline protocols and include T1 pre-gadolinium sagittal images, and be centrally reviewed in order to improve the comparison of clinical trials. PMID:26401129

  14. Echocardiographic assessment of subclinical left ventricular eccentric hypertrophy in adult-onset GHD patients by geometric remodeling: an observational case-control study

    PubMed Central

    de Gregorio, Cesare; Curtò, Lorenzo; Recupero, Antonino; Grimaldi, Patrizia; Almoto, Barbara; Venturino, Marilena; Cento, Domenico; Narbone, Maria Carola; Trimarchi, Francesco; Coglitore, Sebastiano; Cannavò, Salvatore

    2006-01-01

    Background Most patients with growth hormone deficiency (GHD) show high body mass index. Overweight subjects, but GHD patients, were demonstrated to have high left ventricular mass index (LVMi) and abnormal LV geometric remodeling. We sought to study these characteristics in a group of GHD patients, in an attempt to establish the BMI-independent role of GHD. Methods Fifty-four patients, 28 F and 26 M, aged 45.9 ± 13.1, with adult-onset GHD (pituitary adenomas 48.2%, empty sella 27.8%, pituitary inflammation 5.5%, cranio-pharyngioma 3.7%, not identified pathogenesis 14.8%) were enrolled. To minimize any possible interferences of BMI on the aim of this study, the control group included 20 age- and weight-matched healthy subjects. The LV geometry was identified by the relationship between LVMi (cut-off 125 g/m2) and relative wall thickness (cut-off 0.45) at echocardiography. Results There was no significant between-group difference in resting cardiac morphology and function, nor when considering age-related discrepancy. The majority of patients had normal-low LVM/LVMi, but about one fourth of them showed higher values. These findings correlated to relatively high circulating IGF-1 and systolic blood pressure at rest. The main LV geometric pattern was eccentric hypertrophy in 22% of GHD population (26% of with severe GHD) and in 15% of controls (p = NS). Conclusion Though the lack of significant differences in resting LV morphology and function, about 25% of GHD patients showed high LVMi (consisting of eccentric hypertrophy), not dissimilarly to overweight controls. This finding, which prognostic role is well known in obese and hypertensive patients, is worthy to be investigated in GHD patients through wider controlled trials. PMID:16507109

  15. [A case of lymphocytic adenohypophysitis associated with sarcoidosis of the lung and eye].

    PubMed

    Tokunaga, T; Shigemori, M; Katayama, M; Kuramoto, S; Hayashi, H; Yamada, K; Nonaka, K; Sasaguri, Y

    1990-02-01

    Lymphocytic adenohypophysitis is considered to be an inflammatory disease of the adenohypophysis that is commonly present with visual disturbance and hypopituitarism. Its etiology remains unclear but it is often related to an autoimmune disorder involving other organs, such as the thyroid, parathyroid, or adrenal glands. We encountered a rare case of lymphocytic adenohypophysitis associated with sarcoidosis of the lung and eye during the follow-up period. A 23-year-old woman was hospitalized in July 1986, with a one-month history of headache and visual disturbances which began three days after her second normal delivery. On admission, she showed slight visual impairment and had a left temporal superior quadrantanopia. Endocrinological evaluation revealed thyroid and adrenal hypofunction, and low response of human growth hormone to the loading test. A skull X-ray showed normal shaped sella with some erosion of the dorsum. CT scan showed a rounded contrast-enhanced intrasellar mass extending into the suprasellar cistern. MRI (SR: 500/30) showed a homogeneous low intensity mass which contained a small high intensity area on the relative T2-weighted image (2000/50). A biopsy was performed via right frontotemporal craniotomy. The consistency of the resected tissue was firmer than that of pituitary adenoma. Histologically, the tissue showed diffuse lymphocytic infiltration with some normal adenohypophysis. Her postoperative course was uneventful and the visual impairment improved two months later after the operation. Six months after the operation, she was readmitted with complaints of general fatigue and breathlessness. Chest X-ray showed diffuse infiltration throughout both lung fields, but there was no bilateral hilar lymphadenopathy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2186292

  16. The bite force and craniofacial morphology in patients with acromegaly: A pilot study

    PubMed Central

    Aktas-Yılmaz, Banu; Dogan, Arife; Yetkin, Ilhan; Bek, Bulent

    2014-01-01

    Objectives: Acromegaly is a metabolic disorder caused by increased growth hormone secretion. As a consequence of acromegaly some typical craniofacial morphology changes appear. This pilot study was conducted to compare the bite force and the characteristic size and shape of the craniofacial components of acromegalic patients with the healthy Turkish individuals. In additon, the correlations between bite force and craniofacial morphology of patients with acromegaly and control individuals were evaluated. Study Design: The maximum bite force of the participants was recorded with strain-gage transducer. Lateral x-ray scans were made under standard conditions, in centric occlusion. On cephalograms, the linear and angular measurements was performed. Results: Patients with acromegaly showed increased anterior and posterior total face height, ramus length, width of frontal sinuse, gonial angle and a negative difference between maxillary and mandibular protrusions. In addition, females with acromegaly showed larger lower anterior face height and sella turcica, decreased facial angle, increased mandibular plane angle. The cephalometric measurements, except one did not showed correlation with the bite force in acromegalic patients. In control group, significant correlations were observed between anterior total face height and anterior lower face height, mandibular plane angle and gonial angle. Conclusions: The greater changes were observed in the mandible. The maximum bite force of patients with acromegaly showed no difference from healthy individuals. The non-significant difference of bite force between healthy participants and acromegalic patients provide important information for dental treatment and prosthetic rehabilitation of acromegalic patients. Key words:Acromegaly, bite force, cephalometric analysis, mandibular prognathism. PMID:23986010

  17. Assessment of Antero-Posterior Skeletal and Soft Tissue Relationships of Adult Indian Subjects in Natural Head Position and Centric Relation

    PubMed Central

    Latif, Vishnu Ben; Keshavaraj; Rai, Rohan; Hegde, Gautham; Shajahan, Shabna

    2015-01-01

    Background: The aim of this study was to verify the intra-individual reproducibility of natural head position (NHP) in centric relation (CR) position, to prove the inter-individual differences in the Frankfort horizontal plane and sella-nasion line compared with the true horizontal line, and to establish linear norms from A-point, B-point, Pog as well as soft tissue A-point, soft tissue B-point, and soft tissue Pog to nasion true vertical line (NTVL) in adult Indian subjects. Methods: Lateral cephalograms (T1) of Angle’s Class I subjects were taken in NHP and with bite in CR. A second lateral cephalogram (T2) of these subjects with ANB angle in the range 1-4° were taken after 1 week using the same wax bite and both the radiographs were analyzed based on six angular parameters using cephalometric software (Do-it, Dental studio NX version 4.1) to assess the reproducibility of NHP. Linear values of six landmarks were taken in relation to NTVL, and the mean values were calculated. A total of 116 subjects were included in this study. Results: When the cephalometric values of T1 and T2 were analyzed, it was found that, the parameters showed a P < 0.001, indicating the reproducibility of NHP in CR. Mean values for point A, point B, Pog and their soft tissue counterparts were also obtained. Conclusion: The study proved that NHP is a reproducible and accurate when recorded with the mandible in CR. Linear norms for skeletal Class I subjects in relation to NTVL were established. PMID:26124598

  18. Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study.

    PubMed

    Conrad, Jens; Ayyad, Ali; Wüster, Christian; Omran, Wael; Weber, Matthias M; Konerding, Moritz A; Müller-Forell, Wibke; Giese, Alf; Oertel, Joachim

    2016-08-01

    OBJECTIVE Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. METHODS Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. RESULTS In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. CONCLUSIONS Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area. PMID:26722858

  19. Comparison of linear and angular measurements using two-dimensional conventional methods and three-dimensional cone beam CT images reconstructed from a volumetric rendering program in vivo

    PubMed Central

    Oz, U; Orhan, K; Abe, N

    2011-01-01

    Objective The aim of this study was to compare the linear and angular measurements made on two-dimensional (2D) conventional cephalometric images and three-dimensional (3D) cone beam CT (CBCT) generated cephalograms derived from a 3D volumetric rendering program. Methods Pre-treatment cephalometric digital radiographs of 11 patients and their corresponding CBCT images were randomly selected. The digital cephalometric radiographs were traced using Vista Dent OC (GAC International, Inc Bohemia, NY) and by hand. CBCT and Maxilim® (Medicim, Sint-Niklass, Belgium) software were used to generate cephalograms from the CBCT data set that were then linked to the 3D hard-tissue surface representations. In total, 16 cephalometric landmarks were identified and 18 widely used measurements (11 linear and 7 angular) were performed by 2 independent observers. Intraobserver reliability was assessed by calculating intraclass correlation coefficients (ICC), interobserver reliability was assessed with Student t-test and analysis of variance (ANOVA). Mann–Whitney U-tests and Kruskal–Wallis H tests were also used to compare the three methods (P < 0.05). Results The results demonstrated no statistically significant difference between interobserver analyses for CBCT-generated cephalograms (P < 0.05), except for Gonion-Menton (Go-Me) and Condylion-Gnathion (Co-Gn). Intraobserver examinations showed low ICCs, which was an indication of poor reproducibility for Go-Me and Sella-Nasion (S-N) in CBCT-generated cephalograms and poor reproducibility for Articulare-Gonion (Ar-Go) in the 2D hand tracing method (P < 0.05). No statistical significance was found for Vista Dent OC measurements (P > 0.05). Conclusions Measurements from in vivo CBCT-generated cephalograms from Maxilim® software were found to be similar to conventional images. Thus, owing to higher radiation exposure, CBCT examinations should only be used when the inherent 3D information could improve the outcome of treatment. PMID

  20. Two forensic autopsy cases of death from unexpected lesions of the pituitary gland.

    PubMed

    Suzuki, Hideto; Hayashi, Kino; Fukunaga, Tatsushige

    2014-01-01

    Herein, we report the findings of 2 forensic autopsy cases, in which unexpected pituitary lesions were the underlying cause of death. Case 1: A 56-year-old woman was found dead at her home during a cold winter spell. Macroscopic autopsy findings included a difference in the color of blood that filled her left and right cardiac chambers (deep red and dark red, respectively), collapse of both lungs, atrophy of the thyroid gland, and a large tumor arising from the sella turcica. Microscopic examination revealed a pituitary adenoma along with extensive bleeding. The cause of death was considered to be hypothermia, resulting from dysregulation of thermogenesis due to the pituitary adenoma. Case 2: An 86-year-old man with a history of pollakiuria was found dead in a bathtub, with his face and chest submerged in bathwater and his legs positioned outside the bathtub. The macroscopic findings of the autopsy included hyper-inflated lungs, fluid collection in the thoracic cavity, and aspiration of gastric contents in the bronchi. The atherosclerotic changes of the man's coronary and cerebral arteries were considered mild for his age. Microscopic examination showed a marked infiltration of lymphocytes and plasma cells in the posterior pituitary gland, as well as in the liver, pancreas, and submandibular gland. Considering the results of the autopsy and the findings from the investigation conducted at the death scene, we concluded that the man probably lost consciousness following a neurally mediated syncope, which was induced by diabetes insipidus (lymphocytic hypophysitis). After losing consciousness, the man likely fell in the filled bathtub and then drowned. These 2 cases highlight the need for a thorough post-mortem investigation, including a microscopic examination of the pituitary gland. In addition, forensic pathologists should carefully study the pituitary gland in cases where the cause of death is thought to be related to dysfunction of thermoregulation or

  1. Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A 2-Institutional Study

    PubMed Central

    Yoshikane, Frances; Lai, Li Han; Hui, Brian K.; Martins, Deborah B.; Farias-Eisner, Gina; Mandelbaum, Rachel S.; Hoang, Han; Bradley, James P.; Wilson, Libby

    2016-01-01

    Background: Understanding long-term sequelae of cleft treatment is paramount in the refinement of treatment algorithms to accomplish optimized immediate and long-term outcomes. In this study, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery. Methods: Cleft lip/palate and cleft palate patients, 15 years of age and older, were reviewed for demographics, VPI surgery, revisions, and subsequent orthognathic surgery at 2 institutions. Chi-square test, Student’s t test, and logistic regression analyses were performed. Results: In 214 patients reviewed (mean age, 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.2% had unilateral cleft lip and palate, and 20.6% had bilateral cleft lip and palate. A total of 33.6% were diagnosed with VPI and received a sphincter pharyngoplasty (mean age, 11.9 years). When subsequent orthognathic surgery was examined, sphincter pharyngoplasty was not associated with maxillary advancement (P = 0.59) but did correlate with an increase in mandibular surgery from 2.8% to 11.1% (P = 0.02). The indications for mandibular surgery in the pharyngoplasty population were related to congenital micrognathia. When cephalometric analyses were evaluated, sphincter pharyngoplasty resulted in a decreased sella-to-nasion-to-B point angle (mean, 79.0–76.3 degrees, P = 0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by A point-to-nasion-to-B point angles >0.5 (P = 0.02). Conclusions: Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships because of the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur. PMID:27200238

  2. Impaired IGF1-GH axis and new therapeutic options in Alström Syndrome patients: a case series

    PubMed Central

    2009-01-01

    Background Defects of the primary cilium and its anchoring structure, the basal body, cause a number of human genetic disorders, collectively termed ciliopathies: primary ciliary dyskinesia, Bardet-Biedl syndrome, polycystic kidney and liver disease, nephronophthisis, Alström syndrome, Meckel-Gruber syndrome and some forms of retinal degeneration. Alström syndrome is an extremely rare, autosomal recessive genetic disorder characterized by a group of signs and symptoms including infantile onset dilated cardiomyopathy, blindness, hearing impairment/loss, obesity, diabetes, hepatic and renal dysfunction. Because adult growth hormone deficiency and Alström Syndrome share some clinical and metabolic features, we studied the GH-IGF1 axis, using MRI techniques and dynamic tests in 3 unrelated patients with Alström syndrome. Case presentation The patients were hospitalized and the growth hormone stimulatory tests were made, as well as brain MRI. Insulin provocative test revealed a severe GH deficiency in these patients, defined by a peak response to insulin-induced hypoglycemia less than 3 ng/dl and IGF1 concentrations less than – 2SDS. We didn't find multiple pituitary hormone deficiency and we noticed only a severe GH deficiency in all three patients. The MRI study of the diencephalic and pituitary region was suggestive for the diagnosis of empty sella in one patient. One patient received Recombinant-GH replacement for one year with very good results, one underwent a gastric sleeve with a satisfactory outcome, one patient died due to the progression of the cardiac myopathy. Conclusion Future studies are needed to assses if the substitution therapy with Recombinant Growth hormone is cost-effective and without risk in such patients with Alström Syndrome and severe insulin resistance, despite our good results in one patient. Also, careful clinical and genetic studies can contribute to a better understanding of the evolution after different therapeutical attempt in

  3. Significance of the sexual openings and supplementary structures on the phylogeny of brachyuran crabs (Crustacea, Decapoda, Brachyura), with new nomina for higher-ranked podotreme taxa.

    PubMed

    Guinot, Danièle; Tavares, Marcos; Castro, Peter

    2013-01-01

    coxal to coxo-sternal conditions. The coxo-sternal condition is not an intermediate towards the thoracotreme organisation, and a step in heterotreme evolution is the adoption of the coxo-sternal condition. An extreme carcinisition may also result in the sternal arrangement of male gonopores in the form of a "sternitreme" disposition, as in the case of Hymenosomatoidea, which displays a broad thoracic sternum and true sternal male gonopores (as in thoracotremes) together with several plesiomorphic traits that are assumed to represent an old, deeply-rooted heterotreme clade. A sternitreme condition evolved independently in the most ancestral heterotreme clades (such as Hymenosomatoidea) and in Thoracotremata. The older the lineage of a heterotreme is, the higher the possibility of having evolved carcinisation. Evidence that "derived" traits may be the consequence of a strong carcinisation, rather than being recently acquired, necessitates reconsidering certain character states in Brachyura. Eubrachyurans can only evolve either the heterotreme or the thoracotreme arrangement, the consistency of the inferred ancestral characters states providing a useful criterion for evaluating ancestral trait reconstructions. A widened thoracic sternum together with sternal gonopores may be present in carcinised heterotremes such as hymenosomatoids. The thoracic sternum provides a reliable complex of characters that must be carefully interpreted. The hypothesis of a coxo-sternal disposition in Cryptochiroidea and Pinnotheroidea, generally considered thoracotremes, is rejected, and an alternative interpretation of their status is discussed. A new interpretation of the phylogeny of Cryptochiroidea is outlined, but the origin of Pinnotheroidea remains puzzling. The sella turcica, frequently regarded a synapomorphy of Eubrachyura, is redefined as the structure formed by the endosternal intertagmal phragma that connects the tagma/thorax and the tagma/abdomen to thoracic interosternite 7/8. It

  4. Temporal distribution and behaviour of sand flies (Diptera: Psychodidae) in a cutaneous leishmaniasis focus of the Kani Tribe settlements in the Western Ghats, India.

    PubMed

    Srinivasan, R; Jambulingam, P; Kumar, N Pradeep; Selvakumar, M; Edwin, B; Kumar, T Dilip

    2015-08-01

    The temporal distribution of sand flies in relation to environmental factors was studied in the Kani tribe settlements located on the southernmost part of the Western Ghats, Kerala, India, between June 2012 and May 2013. This area is known for occurrence of cutaneous leishmaniasis (CL) cases. Employing hand-held aspirator, light trap and sticky-trap collection methods, a total of 7874 sand fly specimens, comprising 19 species was collected. Sergentomyia baghdadis was predominant species, followed by Phlebotomus argentipes. Sand fly abundance was significantly higher indoors (χ(2)=9241.8; p=0.0001) than outdoors. Mean density of P. argentipes in human dwellings, cattle sheds and outdoors was 7.2±2.9, 27.33±21.1 and 0.64±0.2 females/per man-hour (MHR), respectively. No sand fly species other than P. argentipes was obtained from cattle sheds. Although, sand fly populations were prevalent throughout the year, their abundance fluctuated with seasonal changes. Multiple regression analysis with backward elimination indicated that the increase in precipitation and relative humidity contributed to a significant positive association with the increase in sand fly abundance, while the increase in temperature showed no association. Fully engorged female sand flies tested for blood meal source showed multiple host-blood feeding. Analysis of resting populations of sand flies collected from human shelters indicated that the populations were found maximum on interior walls at 6-8 and >8 ft height, including ceiling during summer (F=83.7, df=6, p=0.001) and at the lower half of the wall at 0 and 0-2 ft height, during monsoon season (F=41.4, df=6, p=0.001). In cooler months, no preference to any height level (F=1.67, df=6, p=0.2) was observed. Proportion of females sand flies with Sella's classification of abdominal stages, namely full-fed, half-gravid and gravid females did not vary significantly (t=1.98, p=0.13827) indoors, confirming their endophilic behaviour. Risk of CL

  5. Preliminary Results of Helical Tomotherapy in Patients with Complex-Shaped Meningiomas Close to the Optic Pathway

    SciTech Connect

    Schiappacasse, Luis Cendales, Ricardo; Sallabanda, Kita; Schnitman, Franco; Samblas, Jose

    2011-01-01

    Meningiomas are the most common benign intracranial tumor. Meningiomas close to the optic pathway represent a treatment challenge both for surgery and radiotherapy. The aim of this article is to describe early results of helical tomotherapy treatment in complex-shaped meningiomas close to the optic pathway. Twenty-eight patients were consecutively treated. All patients were immobilized with a thermoplastic head mask and planned with the aid of a magnetic resonance imaging-computed tomography fusion. All treatments included daily image guidance. Pretreatment symptoms and acute toxicity were recorded. Median age was 57.5 years, and 92.8% patients had Eastern Cooperative Oncology Group performance status scale {<=}1. The most common localizations were the sella turcica, followed by the cavernous sinus and the sphenoid. The most common symptoms were derived from cranial nerve deficits. Tomotherapy was administered as primary treatment in 35.7% of patients, as an adjuvant treatment in 32.4%, and as a rescue treatment after postsurgical progression in 32.1% patients. Most patients were either inoperable or Simpson IV. Total dose varied between 5000 and 5400 cGy; fractionation varied between 180 and 200 cGy. Median dose to the planning target volume was 51.7 Gy (range, 50.2-55.9 Gy). Median coverage index was 0.89 (range, 0.18-0.97). Median homogeneity index was 1.05 (range, 1-1.12). Acute transient toxicity was grade 1 and included headache in 35.7% patients, ocular pain/dryness in 28.5%, and radiation dermatitis in 25%. Thus far, with a maximal follow-up of 3 years, no late effects have been seen and all patients have a radiological stabilization of the disease. Helical tomotherapy offered a safe and effective therapeutic alternative for patients with inoperable or subtotally resected complex-shaped meningiomas close to the optic pathway. Acceptable coverage and homogeneity indexes were achieved with appropriate values for maximal doses delivered to the eyes, lenses

  6. Crustal deformation at the Nankai subduction zone inferred from onshore GPS velocities and seafloor geodetic observations

    NASA Astrophysics Data System (ADS)

    Watanabe, T.; Tadokoro, K.; Ikuta, R.; Okuda, T.; Nagai, S.; Kuno, M.

    2011-12-01

    study, we investigate interplate coupling at the Nankai Trough using onshore GPS velocities derived from Geophysical Survey Institute of Japan and offshore GPS site velocities derived from seafloor geodetic observation. We assume that observed GPS velocities are represented by the superposition of elastic deformation associated with subduction of the PH, rigid block motion of the overriding plate, and error. The plate interface along the Nankai Trough is represented by multiple rectangular faults. Moreover relative plate motion of the PH-AM (Sella et al., 2002) is assigned to the plate interface as a priori constraint.

  7. Management of post-pill amenorrhea.

    PubMed

    Molitch, M E; Reichlin, S

    1979-09-01

    Persistent amenorrhea, an uncommon sequela of oral contraceptive (OC) use, would not be a major problem except for the fact that an estimated 50 million women worldwide use OCs. Following OC use, women often experience some delay in resuming normal menses, but according to most studies, fewer than 1% fail to begin menstruating regularly within 6 months. In about 1/2 of this small percentage of women, failure to resume normal menses within 6 months is caused by an identifiable underlying disorder. The remaining 1/2 are considered to have "postpill amenorrhea," the result of a disruption of the normal hypothalamic-pituitary-ovarian feeding mechanism, which may be reversible with appropriate treatment. In evaluating patients with postpill amenorrhea, it is important to rule out premature ovarian failure, polycystic ovary syndrome, weight loss, and hyperprolactinemia before arriving at a diagnosis of idiopathic postpill amenorrhea. Prior to 6 months, detailed laboratory evaluation is not indicated, but after 6 months of amenorrhea, the history and physical status should again be carefully evaluated. Any history of weight change, galactorrhea, hirsutism, headaches, or "hot flashes" should be noted. On examination, evidence of hirsutism, virilization, expressible galactorrhea, or ovarian enlargement should be sought. The presence of any of these findings warrants laboratory testing. Pregnancy should always be excluded before further testing. If the patient shows no clinical evidence of premature ovarian failure, polycystic ovaries, anorexia nervosa, or hyperprolactinemia, or if laboratory evaluation fails to confirm clinical suspicions, it is appropriate to wait another 6 months before further evaluation. These disorders may be differentiated from idiopathic postpill amenorrhea by measuring serum levels of gonadotropins, estradiol, testosterone, and prolactin and by sella polytomography. It is important to define whether the treatment objective is resumption of a normal

  8. Somatotroph Hyperplasia

    PubMed Central

    Thorner, M. O.; Perryman, R. L.; Cronin, M. J.; Rogol, A. D.; Draznin, M.; Johanson, A.; Vale, W.; Horvath, E.; Kovacs, K.

    1982-01-01

    A 21-yr-old woman with Turner's syndrome presented with signs and symptoms of acromegaly. The serum growth hormone (GH) (95±9.4 ng/ml; mean±SEM) and somatomedin C (11 U/ml) levels were elevated, and an increase in GH levels after glucose instead of normal suppression, increase after thyrotropin-releasing hormone (TRH) administration instead of no change, and decrease after dopamine administration instead of stimulation were observed. The pituitary fossa volume was greater than normal (1,440 mm3) and the presence of a pituitary tumor was assumed. After tissue removal at transsphenoidal surgery, histological study revealed somatotroph hyperplasia rather than a discrete adenoma. Postoperatively, she remained clinically acromegalic and continued to show increased GH and somatomedin levels. A search was made for ectopic source of a growth hormone-releasing factor (GRF). Computer tomographic scan revealed a 5-cm Diam tumor in the tail of the pancreas. Following removal of this tumor, serum GH fell from 70 to 3 ng/ml over 2 h, and remained low for the subsequent 5 mo. Serum somatomedin C levels fell from 7.2 to normal by 6 wk postoperatively. There were no longer paradoxical GH responses to glucose, TRH, and dopamine. Both the medium that held the tumor cells at surgery and extracts of the tumor contained a peptide with GRF activity. The GRF contained in the tumor extract coeluted on Sephadex G-50 chromatography with rat hypothalamic GH-releasing activity. Stimulation of GH from rat somatotrophs in vitro was achieved at the nanomolar range, using the tumor extract. The patient's course demonstrates the importance of careful interpretation of pituitary histology. Elevated serum GH and somatomedin C levels in a patient with an enlarged sella turcica and the characteristic responses seen in acromegaly to TRH, dopamine, and glucose do not occur exclusively in patients with discrete pituitary tumors and acromegaly. This condition can also occur with somatotroph hyperplasia

  9. Development of a monitoring platform for slope instability and sliding prevention : preliminary results

    NASA Astrophysics Data System (ADS)

    Drakatos, G.; Paradissis, D.; Anastasiou, D.; Elias, P.; Marinou, A.; Chousianitis, K.; Papanikolaou, X.; Zacharis, V.; Argyrakis, P.; Papazisi, K.; Makropoulos, K.

    2012-04-01

    Land sliding, as a consequence of slope instability, constitutes a natural catastrophe resulting mainly from geological cause often followed by disastrous impact on both the natural and man-made environment. The reasons causing land slides can vary from purely geological factors, to other relevant or not natural catastrophes, urban or residential expansion, tourist growth in areas under inappropriate geological background, or even a combination of the aforementioned causes The respective consequences, also span a wide range of negative impacts, both for the man-made (e.g. destruction of transportation infrastructure, constructions and urban or sub-urban areas) and the natural environment. Unfortunately, prevention of land slides is still largely ineffective adding to an inefficient and inadequate addressing of the problem, mainly due to the lack of systematic monitoring of such regions and due to the fact that "treatment" overwhelms "prevention". Recent developments in Global Navigation Satellite Systems (GNSS), Satellite Geodesy and satellite differential interferometry (DinSAR), have established these fields as fully equipped, from a scientific and engineering perspective, to act --either as autonomous techniques or in conjunction-- as prevention and/or early warning systems. Such state-of-the-art technology was implemented, in a project undertaken by the Institute of Geodynamics Dionysos Satellite Observatory/Higher Geodesy Laboratory and the Institute for Space Applications and Remote Sensing, in order to evaluate the potential of monitoring slide stability and the assessment of hazard evaluation. Therefore, for the first time in Greece, an attempt was made to develop a monitoring platform for slope instability and sliding prevention at two of the most hazardous, regarding soil instabilities, regions of Peloponnese, namely Sellas and Chalkio (in Messinia and Korinthia respectively). GPS campaigns were carried through, cGPS stations were installed and a network

  10. A study on the reproducibility of cephalometric landmarks when undertaking a three-dimensional (3D) cephalometric analysis

    PubMed Central

    Llamas, José M.; Cibrián, Rosa; Gandia, José L.; Paredes, Vanessa

    2012-01-01

    Objectives: Cone Beam Computerized Tomography (CBCT) allows the possibility of modifying some of the diagnostic tools used in orthodontics, such as cephalometry. The first step must be to study the characteristics of these devices in terms of accuracy and reliability of the most commonly used landmarks. The aims were 1- To assess intra and inter-observer reliability in the location of anatomical landmarks belonging to hard tissues of the skull in images taken with a CBCT device, 2- To determine which of those landmarks are more vs. less reliable and 3- To introduce planes of reference so as to create cephalometric analyses appropriated to the 3D reality. Study design: Fifteen patients who had a CBCT (i-CAT®) as a diagnostic register were selected. To assess the reproducibility on landmark location and the differences in the measurements of two observers at different times, 41 landmarks were defined on the three spatial axes (X,Y,Z) and located. 3.690 measurements were taken and, as each determination has 3 coordinates, 11.070 data were processed with SPSS® statistical package. To discover the reproducibility of the method on landmark location, an ANOVA was undertaken using two variation factors: time (t1, t2 and t3) and observer (Ob1 and Ob2) for each axis (X, Y and Z) and landmark. The order of the CBCT scans submitted to the observers (Ob1, Ob2) at t1, t2, and t3, were different and randomly allocated. Multiple comparisons were undertaken using the Bonferroni test. The intra- and inter-examiner ICC´s were calculated. Results: Intra- and inter-examiner reliability was high, both being ICC ≥ 0.99, with the best frequency on axis Z. Conclusions: The most reliable landmarks were: Nasion, Sella, Basion, left Porion, point A, anterior nasal spine, Pogonion, Gnathion, Menton, frontozygomatic sutures, first lower molars and upper and lower incisors. Those with less reliability were the supraorbitals, right zygion and posterior nasal spine. Key words:Cone Beam

  11. Endoscopic Endonasal Approach in the Management of Rathke’s Cleft Cysts

    PubMed Central

    Solari, Domenico; Cavallo, Luigi Maria; Somma, Teresa; Chiaramonte, Carmela; Esposito, Felice; Del Basso De Caro, Marialaura; Cappabianca, Paolo

    2015-01-01

    endoscopic approach provides a direct access to the supradiaphragmatic space, allowing adequate view and room for the safe removal of selected supradiaphragmatic RCCs, regardless of the sellar size (even a not enlarged sella), and provides a higher likelihood of preserving normal pituitary tissue and functions. PMID:26474185

  12. Characterization of gsp-mediated growth hormone excess in the context of McCune-Albright syndrome.

    PubMed

    Akintoye, Sunday O; Chebli, Caroline; Booher, Susan; Feuillan, Penelope; Kushner, Harvey; Leroith, Derek; Cherman, Natasha; Bianco, Paolo; Wientroub, Shlomo; Robey, Pamela Gehron; Collins, Michael T

    2002-11-01

    McCune-Albright syndrome (MAS) is a disorder characterized by the triad of café-au-lait skin pigmentation, polyostotic fibrous dysplasia of bone, and hyperfunctioning endocrinopathies, including GH excess. The molecular etiology of the disease is postzygotic activating mutations of the GNAS1 gene product, G(s)alpha. The term gsp oncogene has been assigned to these mutations due to their association with certain neoplasms. The aim of this study was to estimate the prevalence of GH excess in MAS, characterize the clinical and endocrine manifestations, and describe the response to treatment. Fifty-eight patients with MAS were screened, and 22 with stigmata of acromegaly and/or elevated GH or IGF-I underwent oral glucose tolerance testing. Twelve patients (21%) had GH excess, based on failure to suppress serum GH on oral glucose tolerance test, and underwent a TRH test, serial GH sampling from 2000-0800 h, and magnetic resonance imaging of the sella. We found that vision and hearing deficits were more common in patients with GH excess (4 of 12, 33%) than those without (2 of 56, 4%). Of interest, patients with a history of precocious puberty and GH excess who had reached skeletal maturity achieved normal adult height despite a history of early epiphyseal fusion. All 9 patients tested had an increase in serum GH after TRH, 11 of 12 (92%) had hyperprolactinemia, and all 8 tested had detectable or elevated nighttime GH levels. Pituitary adenoma was detected in 4 of 12 (33%) patients. All patients with elevated IGF-I levels were treated with cabergoline (7 patients), long-acting octreotide (LAO; 8 patients), or a combination of cabergoline and LAO (4 patients). In six of the seven patients (86%) treated with cabergoline, serum IGF-I decreased, but not to the normal range. In the eight patients treated with LAO alone, IGF-I decreased, and, in four, returned to the normal range. The remaining 4 patients were treated with a combination of cabergoline and LAO. For them

  13. Strain Accumulation Estimated from Seafloor Crustal Deformation at the Nankai Trough, Japan

    NASA Astrophysics Data System (ADS)

    Tadokoro, K.; Watanabe, T.; Nagai, S.; Ikuta, R.; Okuda, T.; Kenji, Y.; Sakata, T.

    2012-12-01

    Our research has developed an observation system for seafloor crustal deformation composed of the kinematic GPS and acoustic ranging techniques [Tadokoro et al., 2006; Ikuta et al., 2008]. We monitored crustal deformation at the Nankai Trough, Japan, where the Philippine Sea Plate subducts beneath the Amurian Plate. The convergence rate is predicted at 60 mm/y in the N59W direction by the Euler vector of REVEL [Sella et al., 2002]. We installed three monitoring sites (named KMN, KMS, and KME) on the seafloor at depths of about 1920-2030 m. The sites KMN and KMS are installed perpendicular to the trough axis with a spacing of 20 km; the site KME is 50 km from KMN and KMS in the direction parallel to the trough axis. The monitoring was started in 2004, 2005, and 2008 at KMS, KMN, and KME, respectively. The numbers of measurements are 16, 20, and 5 times at KMN, KMS, and KME, respectively. We obtained 3-7 years averaged horizontal site velocities within ITRF2000 adopting a robust estimation method with Tukey's biweight function to the time series of site position measured until the end of 2011. Substituting the synthetic rigid block motions of the Amurian Plate from the velocities within ITRF2000, we obtained the following site velocities with respect to the Amurian Plate [Tadokoro et al., 2012]: KMN 41±4 mm/y, N77±7W KMS 43±5 mm/y, N80±6W KME 42±5 mm/y, N80±7W In contrast, the on-land GPS horizontal velocities along the coast is 23-33 mm/y toward N74-80W. The present observational results show: (1) the velocity vectors are all the same length and direction, which indicates no internal deformation in this region; (2) the back-slip model predicts that the plate interface beneath the region is uniformly locked with coupling ratios of 60-80 %, indicating strain accumulation that will be released during the anticipated mega-thrust Tonankai earthquake; and (3) the directions of site velocities differ from that of convergence vector by 20 degrees, which is affected by

  14. Penetrating gunshots to the head and lack of immediate incapacitation. II. Review of case reports.

    PubMed

    Karger, B

    1995-01-01

    Because of the enhanced intracranial tissue disruption (see companion paper) and the functional significance of the central nervous system, penetrating gunshot wounds of the head commonly result in immediate incapacitation. However, in the last century numerous publications reported sustained capability to act following penetrating gunshot wounds of the head. These are reviewed. A large number of case reports had to be excluded from re-examination because of doubtful capability to act or lack of morphological documentation. There remained 53 case reports from 42 sources for systematic analysis. Favourable conditions for sustained capability to act are present in cases where the additional wounding resulting from the special wound ballistic qualities of the head (see companion paper) are minimized. Thus, more than 70% of the guns used fired slow and lightweight bullets: 6.35 mm Browning, .22 rimfire or extremely ineffective projectiles (ancient, inappropriate or selfmade). A centre-fire rifle or a shotgun from close range were never employed in cases involving intracerebral tracts. A coincidence of several lucky circumstances made sustained capability to act possible in two cases of military centrefire rifle bullets passing longitudinally between the frontal lobes without direct contact with brain tissue. Only two large handguns resulting in intracerebral wounding were used: one firing a .38 special bullet, which solely wounded the base of the right temporal lobe and one firing a .45 lead bullet, which seriously injured the left frontal lobe but whose trajectory was limited to the anterior fossa of the skull. Of the trajectories, 28% were outside the neurocranium. At least 70% of the craniocerebral tracts passed above the anterior fossa of the skull, wounding the frontal parts of the brain. Apart from a neurophysiological approach, this preference can be explained by the fact that the base of the anterior cranial fossa and the sella turcica area serve as a bony

  15. Ancient views on the hypothalamic-pituitary-thyroid axis: an historical and epistemological perspective.

    PubMed

    Toni, R

    2000-10-01

    The modern views on the anatomical and physiological interactions between the hypothalamus, pituitary and thyroid gland have emerged only in the last fifty years, although their historical roots may be found in a number of ancient and still not widely known ideas and observations. The regulation of energy body stores and temperature by the hypothalamic-pituitary-thyroid axis, for example, is a classical case of "fixitè du mileu interieur" in the sense originally suggested by Claude Bernard in the late 1800s, i.e. a homeostatic mechanism, but already 2100 year previously Aristotle had stated that the brain was necessary for the maintenance of body integrity by regulating food intake and behavior in relation to body temperature, the latter primarily determined by the heat of the blood. Five hundred years later Galen of Pergamon reported fundamental discoveries in the anatomy of the third ventricle region, including the location of the pituitary gland inside the sella turcica embodied in a vascular network, the rete mirabilis, and observed nerves adjoining the "soft flesh" in the neck, i.e. the thyroid gland. He first proposed that the energy of the body (the vital spirit) was carried through the arteries at the level of the rete mirabilis, where it was transformed into nerve impulse (the animal spirit), eventually transferred by the nerves to the periphery of the body, "glands" included, raising implicitly the possibility for a nervous influence over the thyroid activity. The Galenic model remained virtually unaltered up to the beginning of the 14th century, when the mediaeval anatomist Mondino de' Liuzzi put forth the idea that the thyroid gland interacted with the heat of the blood present in the internal carotid arteries due to their anatomical relation with the thyroid. This interaction enriched the vital spirit, i.e. the energy of the body, prior to its transformation into animal spirit, i.e. to nerve impulse directed to the periphery of the body. In addition

  16. Structural and geomorphic fault segmentations of the Doruneh Fault System, central Iran

    NASA Astrophysics Data System (ADS)

    Farbod, Yassaman; Bellier, Olivier; Shabanian, Esmaeil; Abbassi, Mohammad Reza

    2010-05-01

    The active tectonics of Iran results from the northward Arabia-Eurasia convergence at a rate of ~22±2 mm/yr at the longitude of Bahrain (e.g., Sella et al., 2002). At the southwestern and southern boundaries of the Arabia-Eurasia collision zone, the convergence is taken up by the continental collision in the Zagros Mountains, and the active subduction of Makran, respectively. Further north, the northward motion not absorbed by the Makran subduction is expressed as the N-trending right lateral shear between central Iran and Eurasia at a rate of ~16 mm/yr (e.g., Regard et al., 2005; Vernant et al, 2004). This shear involves N-trending right-lateral fault systems, which are extended at both sides of the Lut block up to the latitude of 34°N. North of this latitude, about 35°N, the left-lateral Doruneh Fault separates the N-trending right-lateral fault systems from the northern deformation domains (i.e., the Alborz, Kopeh Dagh and Binalud mountain ranges). At the Iranian tectonic scale, the Doruneh Fault represents a curved-shape, 600-km-long structure through central Iran, which runs westward from the Iran-Afghanistan boundary (i.e., the eastern boundary of the Arabia-Eurasia collision zone) to the Great Kavir desert. Nevertheless, east of the longitude of 56°45'E, the fault is expressed as an E-trending ~360-km-long fault (hereinafter the Doruneh Fault System - DFS) having a geological evolution history different from the western part (the Great Kavir Fault System). In this study, we look for characterizing geomorphic and structural features of active faulting on the DFS. Detailed structural and geomorphic mapping based on satellite Imageries (SPOT5 and Landsat ETM+) and SRTM digital topographic data, complemented with field surveys allowed us to establish structural and geomorphic segmentations along the DFS. According to our observations, the DFS is comprised of three distinct fault zones: (1) The 100-km-long, N75°E-trending western fault zone, which is

  17. Anatomical basis of LMA variations drive to different photosynthetic and water storage strategies in two Sesleria species from mountain dry grasslands

    NASA Astrophysics Data System (ADS)

    Puglielli, Giacomo; Fiore Crescente, Maria; Frattaroli, Anna Rita; Gratani, Loretta

    2016-04-01

    Plant and leaf traits directly affect ecosystem processes ensuring carbon, nutrient and water exchanges between soil and atmosphere through the photosynthetic activity. Nevertheless, a great within sites variation in plant and leaf traits can be found resulting in different adaptive strategies in coexisting species. Leaf mass per unit of leaf area (LMA) is an important trait to understand plant functional ecology being the outcome of leaf anatomy and related to photosynthesis. We hypothesized that LMA was the main predictor of the adaptive strategies of Sesleria nitida (S1) and Sesleria juncifolia (S2), growing on the screes and on the crests of the summit area, respectively, on Mount Terminillo (Central Apennines, Loc. Sella di Leonessa, 1895 m a.s.l.). To test our hypothesis we broke LMA down into anatomical components, leaf tissue density (LTD) and thickness (LT) and then relating them to gas exchange parameters on twenty plants per species cultivated ex situ. LTD explained 69% of LMA variations in S1 while the relationship with LT was not significant. Moreover, LTD was negatively correlated with LT in S1 driving to a 17% higher volume of the intercellular air spaces, which increases the CO2 partial pressure at the carboxylation sites. This result was also attested by the significant relationship between LTD and both net photosynthesis per unit leaf area (Aa) and mass (Am) (R= 0.56 and -0.49, respectively), highlighting the role of LTD in determining the photosynthetic process in S1. LMA scaled with both LTD and LT explaining 82% and 70% of LMA variations in S2. Moreover, the positive relationship between LTD and LT (R2 = 0.52) highlighted a coordination between the variables in controlling the photosynthetic process. In particular, LTD and LT controlled the transactions of carbon and water through the leaf surface, being positively related to Aa (R= 0.93 and 0.79 for LTD and LT, respectively). Nevertheless, an increase in LT and LTD decreased Am (R = -0.9 and

  18. Active faulting induced by the slip partitioning in the Lesser Antilles arc

    NASA Astrophysics Data System (ADS)

    Leclerc, Frédérique; Feuillet, Nathalie

    2010-05-01

    ée. Some faults, located between Guadeloupe and Montserrat have throws up to thousand meters. Between St Lucia and Martinique, the St Lucia channel is crosscut by several normal faults with scarps up to 100m-high. These faults extend onshore and cut the southern shore of Martinique. Given their length (~20km), they could produce magnitude 6 or more earthquakes in the most tourist towns of the island (St Anne, St Lucie). Recent coseismic offsets could be identified along most faults in the chirp profiles. Turbidite deposits recognized in the Küllenberg cores could be related to damaging earthquakes. High resolution SAR imagery (25 cm) reveals several coseismic scarps in Les Saintes channel along the faults that ruptured in 2004. References: Feuillet, N., I. Manighetti, and P. Tapponnier, Arc parallel extension and localization of volcanic complexes in guadeloupe, lesser antilles, Journal of Geophysical Research, 107, 2002. Feuillet, N., P. Tapponnier, I. Manighetti, B. Villemant, and G. C. P. King, Differential uplift and tilt of pleistocene reef platforms and quaternary slip Lopez, A.M., S. Stein, T. Dixon, G. Sella, E. Calais, P. Jansma, J. Weber, and P. La Femina, Is there a northern lesser antilles forearc block ?, Geophysical Research Letters, 33, 2006.

  19. Attenuation of D-1 antagonist-induced D-1 receptor upregulation by conccomitant D-2 receptor blockade

    SciTech Connect

    Parashos, S.A.; Barone, P.; Tucci, I.; Chase, T.N.

    1987-11-16

    The effect of chronic selective D-1 and/or D-2 dopamine receptor blockade on regional D-1 receptor binding was studied in rat brain following chronic treatment with the specific D-1 antagonist SCH 23390 and/or the predominantly D-2 antagonist haloperidol. D-1 receptor density and affinity were evaluated by quantitative autoradiography using /sup 125/I-SCH 23982. Chronic SCH 23390 treatment increased D-1 receptor density by 30 to 40% in the striatum, accumbens and tuberculum olfactorium; receptor affinity remained unchanged. Haloperidol had no effect on D-1 receptor Bmax or Kd values, although, when administered with SCH 23390, reduced the D-1 receptor upregulation induced by the D-1 antagonist in striatum and tuberculum olfactorium, but not in nucleus accumbens, These results may be attributable to D-1/D-2 dopamine receptor interactions occurring in the striatum and tuberculum olfactorium and may have implications for the prevention and treatment of drug-induced extrapyramidal disorders. 34 references, 1 figure, 2 tables.

  20. Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage.

    PubMed

    Sadek, Ahmed-Ramadan; Gregory, Stephen; Jaiganesh, Thiagarajan

    2011-01-01

    symptoms and lack of prodrome, an urgent CT head scan was performed to rule out a cerebrovascular event. The scan demonstrated an enlarged pituitary gland (3 cm in diameter) with impingement of the optic chiasm. The centre of the enlarged pituitary gland was noted to be hypodense in comparison to its periphery, which was consistent with a diagnosis of pituitary apoplexy. A subsequent MRI confirmed the diagnosis (Figure 1) of an enlarged sella containing abnormal soft tissue with increased signal intensity suggestive of haemorrhage (Figure 1A).Post-MRI a lumbar puncture was performed revealing glucose 3.4 mmol/l, protein 1.0 g/l, red cells of 53/mm3 and white cells of 174/mm3 with predominant neutrophilia. No organisms were seen, and CSF cultures and HSV DNA tests were found to be negative. Endocrinological investigations demonstrated low concentrations of thyroid hormones [TSH: 0.14 mIu/l (0.35-5.5 mlU/l), FT3: 1.1 nmol/l (1.2-3.0 nmol/l), FT4: 9.6 pmol/l (8-22 pmol/l)], gonadal hormones (LH: < 1 u/l) and prolactin: 16 u/l (<450 u/l). Serum FSH was 2.9 u/l (0.8-11.5 u/L) and cortisol 575 nmol/l (450-700 nmol/l). The patient was treated for hypopituitarism based on clinical and radiological findings with intravenous fluids, hydrocortisone (100 mg) and thyroxine (50 μg) as loading doses in the ED.Within 24 h of commencement of therapy the patient's GCS rose to 15, and within 48 h there was marked improvement in the right sixth cranial nerve palsy. Formal visual field assessment demonstrated temporal visual field loss in the left eye. The patient was discharged to his usual residence a week later and follow-up was organised with both the endocrinologists and ophthalmologists. Follow-up MRI demonstrated that there was no significant change in either size or signal characteristics of the pituitary fossa mass (Figure 1B). PMID:21975129

  1. Pharmacological characterization of binding sites identified in rat brain following in vivo administration of [3H]-spiperone.

    PubMed Central

    Chivers, J.; Jenner, P.; Marsden, C. D.

    1987-01-01

    [3H]-spiperone is commonly used to label dopamine receptors in vitro in brain tissue. However, spiperone also interacts with brain 5-hydroxytryptamine and noradrenaline receptors. In vivo, [3H]-spiperone has been used for identifying dopamine receptors in both animals and man but the nature of the sites identified is unknown. The in vivo administration of [3H]-spiperone to rats leads to a selective accumulation of radioactivity in the olfactory lobes, tuberculum olfactorium, nucleus accumbens, striatum, substantia nigra, hippocampus, frontal cortex and hypothalamus, when compared to the cerebellum. In vivo drug displacement studies suggest that the binding of [3H]-spiperone in these areas may be to dopamine, 5-HT or noradrenaline receptors. [3H]-spiperone in vivo mainly labels dopamine receptors in striatum, tuberculum olfactorium, hypothalamus, substantia nigra and olfactory lobes. However, in the frontal cortex and nucleus accumbens specific binding involves not only dopamine receptors but also 5-HT and/or noradrenaline receptors. Interpretation of in vivo studies in man using radioactive spiperone and its derivatives must take into account the fact that this ligand only labels dopamine receptors in some brain areas. PMID:2882801

  2. [Preliminary results of noncontact temperature measuring using an infrared thermometer on the tarsus pf swine with osteoarthrosis tarsi deformans].

    PubMed

    Sabec, D; Lazar, P

    1990-01-01

    The surface temperature on tarsus of 54 performance tested boars of about 60 kg of Swedish Landrace was measured by means of infra-red thermometer at three measuring points (MP1, MP2 and MP3). MP1 was situated above the tuberculum of os metatarsale III or, as visualised in 21 slaughtered boars, above pathoanatomical alterations of osteoarthrosis tarsi deformans (OATD). MP2 was located directly medially and MP3 laterally from MP1. A clear palpatory symptom was found only with 10 boars, while all 21 slaughtered boars showed different morphological lesions of OATD. The average temperature at MP1 was 35.69 degrees C and was significantly higher (P = .01) than at MP2 (35.34) and MP3 (35.30). The temperature differences between MP1 and MP2 or MP3 were statistically reliable. Boars, who had a clear palpatory symptoms at tuberculum, showed an average temperature at MT1 of 36.27 degrees C, which was higher (P = .0114) than of those with an unclear palpatory symptom (35.64 degrees C). The results show that the temperature differences are the consequence of OATD. PMID:2311530

  3. Afferent Connectivity of the Zebrafish Habenulae

    PubMed Central

    Turner, Katherine J.; Hawkins, Thomas A.; Yáñez, Julián; Anadón, Ramón; Wilson, Stephen W.; Folgueira, Mónica

    2016-01-01

    The habenulae are bilateral nuclei located in the dorsal diencephalon that are conserved across vertebrates. Here we describe the main afferents to the habenulae in larval and adult zebrafish. We observe afferents from the subpallium, nucleus rostrolateralis, posterior tuberculum, posterior hypothalamic lobe, median raphe; we also see asymmetric afferents from olfactory bulb to the right habenula, and from the parapineal to the left habenula. In addition, we find afferents from a ventrolateral telencephalic nucleus that neurochemical and hodological data identify as the ventral entopeduncular nucleus (vENT), confirming and extending observations of Amo et al. (2014). Fate map and marker studies suggest that vENT originates from the diencephalic prethalamic eminence and extends into the lateral telencephalon from 48 to 120 hour post-fertilization (hpf). No afferents to the habenula were observed from the dorsal entopeduncular nucleus (dENT). Consequently, we confirm that the vENT (and not the dENT) should be considered as the entopeduncular nucleus “proper” in zebrafish. Furthermore, comparison with data in other vertebrates suggests that the vENT is a conserved basal ganglia nucleus, being homologous to the entopeduncular nucleus of mammals (internal segment of the globus pallidus of primates) by both embryonic origin and projections, as previously suggested by Amo et al. (2014). PMID:27199671

  4. Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder. A controlled radiological study.

    PubMed

    Beyeler, C; Lehmann, T; Schlapbach, P; Gerber, N J; Fuchs, W A

    1995-01-01

    The prevalence of hyperostotic spurs (HS) in different areas of the shoulder was studied in 36 probands with and 58 probands without thoracospinal hyperostosis on lateral chest radiographs. Bilateral shoulder radiographs in three projections were analysed blindly, recording the presence of HS at six separate sites (glenoid, greater tuberculum, acromion, acromioclavicular joint, coracoid and humeral shaft) and applying defined grading criteria. The prevalence of HS ranged from 11.7% of the shoulders at the coracoid to 50.0% at the glenoid. The prevalence of HS was similar on both sides [right, 30.1% of the sites versus left, 27.0%, relative risk (RR) 1.12 (95% confidence interval [Cl] 0.93-1.35)] and was not related to sex and history of work. Classification for the presence of shoulder hyperostosis was identical on both sides with the exception of one individual. In probands with thoracospinal and shoulder hyperostosis all areas analysed contributed to the classification. However, this was particularly prominent at the humeral shaft [RR 5.3 (95% Cl 2.1-13.0)] and the coracoid [RR 8.4 (95% Cl 1.9-36.4)]. These results indicated that the prevalence of HS and the specificity for the presence of diffuse idiopathic skeletal hyperostosis (DISH) vary between different sites. We suggest that future grading criteria for shoulder hyperostosis take into account the localization of HS, in addition to their number and size. PMID:8588119

  5. Vocal-Motor and Auditory Connectivity of the Midbrain Periaqueductal Gray in a Teleost Fish

    PubMed Central

    Kittelberger, J. Matthew; Bass, Andrew H.

    2012-01-01

    The midbrain periaqueductal gray (PAG) plays a central role in the descending control of vocalization across vertebrates. The PAG has also been implicated in auditory-vocal integration, though its precise role in such integration remains largely unexplored. Courtship and territorial interactions in plainfin midshipman fish depend on vocal communication, and the PAG is a central component of the midshipman vocal-motor system. We made focal neurobiotin injections into the midshipman PAG to both map its auditory-vocal circuitry and enable evolutionary comparisons with tetrapod vertebrates. These injections revealed an extensive bidirectional pattern of connectivity between the PAG and known sites in both the descending vocal-motor and ascending auditory systems, including portions of the telencephalon, dorsal thalamus, hypothalamus, posterior tuberculum, midbrain and hindbrain. Injections in the medial PAG produced dense label within hindbrain auditory nuclei, while those confined to the lateral PAG preferentially labeled hypothalamic and midbrain auditory areas. Thus, the teleost PAG may have functional subdivisions playing different roles in vocal-auditory integration. Together, the results confirm several pathways previously identified by injections into known auditory or vocal areas and provide strong support for the hypothesis that the teleost PAG is centrally involved in auditory-vocal integration. PMID:22826153

  6. BAC transgenic zebrafish reveal hypothalamic enhancer activity around obesity associated SNP rs9939609 within the human FTO gene.

    PubMed

    Rinkwitz, Silke; Geng, Fan-Suo; Manning, Elizabeth; Suster, Maximiliano; Kawakami, Koichi; Becker, Thomas S

    2015-10-01

    Single Nucleotide Polymorphisms in FTO intron 1 have been associated with obesity risk, leading to the hypothesis that FTO is the obesity-related gene. However, other studies have shown that the FTO gene is part of the regulatory domain of the neighboring IRX3 gene and that enhancers in FTO intron 1 regulate IRX3. While Irx3 activity was shown to be necessary in the hypothalamus for the metabolic function of Irx3 in mouse, no enhancers with hypothalamic activity have been demonstrated in the risk-associated region within FTO. In order to identify potential enhancers at the human FTO locus in vivo, we tested regulatory activity in FTO intron 1 using BAC transgenesis in zebrafish. A minimal gata2 promoter-GFP cassette was inserted 1.3 kb upstream of the obesity associated SNP rs9939609 in a human FTO BAC plasmid. In addition to the previously identified expression domains in notochord and kidney, human FTO BAC:GFP transgenic zebrafish larvae expressed GFP in the ventral posterior tuberculum, the posterior hypothalamus and the anterior brainstem, which are also expression domains of zebrafish irx3a. In contrast, an in-frame insertion of a GFP cassette at the FTO start codon resulted in weak ubiquitous GFP expression indicating that the promoter of FTO does likely not react to enhancers located in the obesity risk-associated region. PMID:26271004

  7. Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis--a systematic review.

    PubMed

    Huisstede, Bionka M A; Gebremariam, Lukas; van der Sande, Renske; Hay, Elaine M; Koes, Bart W

    2011-10-01

    Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and non-calcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we assessed the evidence for effectiveness of ESWT for these disorders. The Cochrane Library, PubMed, Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers independently extracted data and assessed the methodological quality. Seventeen RCTs (11 calcific, 6 non-calcific) were included. For calcific RC-tendinosis, strong evidence was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term. Moderate evidence was found in favour of high-ESWT versus placebo in short-, mid- and long-term and versus low-ESWT in mid- and long-term. Moreover, high-ESWT was more effective (moderate evidence) with focus on calcific deposit versus focus on tuberculum major in short- and long-term. RSWT was more effective (moderate evidence) than placebo in mid-term. For non-calcific RC-tendinosis, no strong or moderate evidence was found in favour of low-, mid- or high-ESWT versus placebo, each other, or other treatments. This review shows that only high-ESWT is effective for treating calcific RC-tendinosis. No evidence was found for the effectiveness of ESWT to treat non-calcific RC-tendinosis. PMID:21396877

  8. Localization of BDNF expression in the developing brain of zebrafish

    PubMed Central

    De Felice, E; Porreca, I; Alleva, E; De Girolamo, P; Ambrosino, C; Ciriaco, E; Germanà, A; Sordino, P

    2014-01-01

    The brain-derived neurotrophic factor (BDNF) gene is expressed in differentiating and post-mitotic neurons of the zebrafish embryo, where it has been implicated in Huntington's disease. Little is known, however, about the full complement of neuronal cell types that express BDNF in this important vertebrate model. Here, we further explored the transcriptional profiles during the first week of development using real-time quantitative polymerase chain reaction (RT-qPCR) and whole-mount in situ hybridization (WISH). RT-qPCR results revealed a high level of maternal contribution followed by a steady increase of zygotic transcription, consistent with the notion of a prominent role of BDNF in neuronal maturation and maintenance. Based on WISH, we demonstrate for the first time that BDNF expression in the developing brain of zebrafish is structure specific. Anatomical criteria and co-staining with genetic markers (shh, pax2a, emx1, krox20, lhx2b and lhx9) visualized major topological domains of BDNF-positive cells in the pallium, hypothalamus, posterior tuberculum and optic tectum. Moreover, the relative timing of BDNF transcription in the eye and tectum may illustrate a mechanism for coordinated development of the retinotectal system. Taken together, our results are compatible with a local delivery and early role of BDNF in the developing brain of zebrafish, adding basic knowledge to the study of neurotrophin functions in neural development and disease. PMID:24588510

  9. Vasoactive intestinal peptide binding sites and fibers in the brain of the pigeon Columba livia: An autoradiographic and immunohistochemical study

    SciTech Connect

    Hof, P.R.; Dietl, M.M.; Charnay, Y.; Martin, J.L.; Bouras, C.; Palacios, J.M.; Magistretti, P.J. )

    1991-03-15

    The distribution of vasoactive intestinal peptide (VIP) binding sites in the pigeon brain was examined by in vitro autoradiography on slide-mounted sections. A fully characterized monoiodinated form of VIP, which maintains the biological activity of the native peptide, was used throughout this study. The highest densities of binding sites were observed in the hyperstriatum dorsale, archistriatum, auditory field L of neostriatum, area corticoidea dorsolateralis and temporo-parieto-occipitalis, area parahippocampalis, tectum opticum, nucleus dorsomedialis anterior thalami, and in the periventricular area of the hypothalamus. Lower densities of specific binding occurred in the neostriatum, hyperstriatum ventrale and nucleus septi lateralis, dorsolateral area of the thalamus, and lateral and posteromedial hypothalamus. Very low to background levels of VIP binding were detected in the ectostriatum, paleostriatum primitivum, paleostriatum augmentatum, lobus parolfactorius, nucleus accumbens, most of the brainstem, and the cerebellum. The distribution of VIP-containing fibers and terminals was examined by indirect immunofluorescence using a polyclonal antibody against porcine VIP. Fibers and terminals were observed in the area corticoidea dorsolateralis, area parahippocampalis, hippocampus, hyperstriatum accessorium, hyperstriatum dorsale, archistriatum, tuberculum olfactorium, nuclei dorsolateralis and dorsomedialis of the thalamus, and throughout the hypothalamus and the median eminence. Long projecting fibers were visualized in the tractus septohippocampalis. In the brainstem VIP immunoreactive fibers and terminals were observed mainly in the substantia grisea centralis, fasciculus longitudinalis medialis, lemniscus lateralis, and in the area surrounding the nuclei of the 7th, 9th, and 10th cranial nerves.

  10. [A Case of an Older Patient with Metastatic Breast Cancer Effectively Treated with Capecitabine, with Achievement of cCR].

    PubMed

    Ono, Yoko; Enomoto, Katsuhisa; Sakurai, Kenichi; Amano, Sadao

    2015-11-01

    A case: An 82-year-old woman underwent Bp plus Ax enforcement for carcinoma of the right breast (T2N1M0, StageⅡB) about 5 years previously. Letrozole was administered, but right pleura tuberculum and pleural dissemination was noted in the fifth postoperative year. The hormone therapy was changed, but mediastinal lymph node metastases were observed with tumor marker elevation and bilateral metastases in the lung and right pleural fluid retention. Capecitabine 1,800 mg/day for 3 weeks was started in the sixth postoperative year. The response to treatment was classified as cCR and no side effects were noted. For approximately 1 year and 6 months, no recurrence or metastasis has been observed. Consecutive therapy such as onset of the side effect or an injection method change, dosage weight loss is difficult though chemotherapies is performed for the recurrence metastasis breast cancer case of the older patient. Because capecitabine is isolated, and a continuous administration is had without a side effect, and it was with cCR for this case, in addition, discussion of the literature is reported because it seemed that it may be in effective therapy for an older patient breast cancer case in future. PMID:26805119

  11. A Novel Neural Substrate for the Transformation of Olfactory Inputs into Motor Output

    PubMed Central

    Derjean, Dominique; Moussaddy, Aimen; Atallah, Elias; St-Pierre, Melissa; Auclair, François; Chang, Steven; Ren, Xiang; Zielinski, Barbara; Dubuc, Réjean

    2010-01-01

    It is widely recognized that animals respond to odors by generating or modulating specific motor behaviors. These reactions are important for daily activities, reproduction, and survival. In the sea lamprey, mating occurs after ovulated females are attracted to spawning sites by male sex pheromones. The ubiquity and reliability of olfactory-motor behavioral responses in vertebrates suggest tight coupling between the olfactory system and brain areas controlling movements. However, the circuitry and the underlying cellular neural mechanisms remain largely unknown. Using lamprey brain preparations, and electrophysiology, calcium imaging, and tract tracing experiments, we describe the neural substrate responsible for transforming an olfactory input into a locomotor output. We found that olfactory stimulation with naturally occurring odors and pheromones induced large excitatory responses in reticulospinal cells, the command neurons for locomotion. We have also identified the anatomy and physiology of this circuit. The olfactory input was relayed in the medial part of the olfactory bulb, in the posterior tuberculum, in the mesencephalic locomotor region, to finally reach reticulospinal cells in the hindbrain. Activation of this olfactory-motor pathway generated rhythmic ventral root discharges and swimming movements. Our study bridges the gap between behavior and cellular neural mechanisms in vertebrates, identifying a specific subsystem within the CNS, dedicated to producing motor responses to olfactory inputs. PMID:21203583

  12. Localization of nitric oxide synthase in the brain of the frog, Xenopus laevis.

    PubMed

    Brüning, G; Mayer, B

    1996-11-25

    Nitric oxide synthase was localized in the brain of the South african clawed frog by NADPH diaphorase histochemistry and immunohistochemistry. All structures stained by the antiserum also displayed NADPH diaphorase activity. The fiber bundles of the terminal nerve, however, were positive for NADPH diaphorase but were not immunoreactive. In the forebrain, neurons expressing nitric oxide synthase were concentrated to the pallium, striatum, nucleus accumbens and anterior entopeduncular nucleus. Strongly stained neurons in the diencephalon were detected in the lateral thalamus, the tuberculum posterior and in the ventral hypothalamus. In the mesencephalon, the tectum and the magnocellular nucleus of the torus semicircularis contained many positive cells. Farther caudally, intensely stained neurons were abundant in an area corresponding to the anuran locus coeruleus, in the descending nucleus of the trigeminus and the inferior reticular nucleus. In the cerebellum, Purkinje cells were weakly stained. In summary, the expression pattern of nitric oxide synthase in the anuran brain reveals similarities to that of other vertebrates. The strongly positive cell group in the locus coeruleus may correspond to cholinergic cell groups in the mesopontine area in mammals. PMID:9001739

  13. A novel neural substrate for the transformation of olfactory inputs into motor output.

    PubMed

    Derjean, Dominique; Moussaddy, Aimen; Atallah, Elias; St-Pierre, Melissa; Auclair, François; Chang, Steven; Ren, Xiang; Zielinski, Barbara; Dubuc, Réjean

    2010-01-01

    It is widely recognized that animals respond to odors by generating or modulating specific motor behaviors. These reactions are important for daily activities, reproduction, and survival. In the sea lamprey, mating occurs after ovulated females are attracted to spawning sites by male sex pheromones. The ubiquity and reliability of olfactory-motor behavioral responses in vertebrates suggest tight coupling between the olfactory system and brain areas controlling movements. However, the circuitry and the underlying cellular neural mechanisms remain largely unknown. Using lamprey brain preparations, and electrophysiology, calcium imaging, and tract tracing experiments, we describe the neural substrate responsible for transforming an olfactory input into a locomotor output. We found that olfactory stimulation with naturally occurring odors and pheromones induced large excitatory responses in reticulospinal cells, the command neurons for locomotion. We have also identified the anatomy and physiology of this circuit. The olfactory input was relayed in the medial part of the olfactory bulb, in the posterior tuberculum, in the mesencephalic locomotor region, to finally reach reticulospinal cells in the hindbrain. Activation of this olfactory-motor pathway generated rhythmic ventral root discharges and swimming movements. Our study bridges the gap between behavior and cellular neural mechanisms in vertebrates, identifying a specific subsystem within the CNS, dedicated to producing motor responses to olfactory inputs. PMID:21203583

  14. Circadian Modulation of Dopamine Levels and Dopaminergic Neuron Development Contributes to Attention Deficiency and Hyperactive Behavior

    PubMed Central

    Huang, Jian; Zhong, Zhaomin; Wang, Mingyong; Chen, Xifeng; Tan, Yicheng; Zhang, Shuqing; He, Wei; He, Xiong; Huang, Guodong; Lu, Haiping; Wu, Ping; Che, Yi; Yan, Yi-Lin; Postlethwait, John H.; Chen, Wenbiao

    2015-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and adults. While ADHD patients often display circadian abnormalities, the underlying mechanisms are unclear. Here we found that the zebrafish mutant for the circadian gene period1b (per1b) displays hyperactive, impulsive-like, and attention deficit-like behaviors and low levels of dopamine, reminiscent of human ADHD patients. We found that the circadian clock directly regulates dopamine-related genes monoamine oxidase and dopamine β hydroxylase, and acts via genes important for the development or maintenance of dopaminergic neurons to regulate their number and organization in the ventral diencephalic posterior tuberculum. We then found that Per1 knock-out mice also display ADHD-like symptoms and reduced levels of dopamine, thereby showing highly conserved roles of the circadian clock in ADHD. Our studies demonstrate that disruption of a circadian clock gene elicits ADHD-like syndrome. The circadian model for attention deficiency and hyperactive behavior sheds light on ADHD pathogenesis and opens avenues for exploring novel targets for diagnosis and therapy for this common psychiatric disorder. PMID:25673850

  15. Vocal-motor and auditory connectivity of the midbrain periaqueductal gray in a teleost fish.

    PubMed

    Kittelberger, J Matthew; Bass, Andrew H

    2013-03-01

    The midbrain periaqueductal gray (PAG) plays a central role in the descending control of vocalization across vertebrates. The PAG has also been implicated in auditory-vocal integration, although its precise role in such integration remains largely unexplored. Courtship and territorial interactions in plainfin midshipman fish depend on vocal communication, and the PAG is a central component of the midshipman vocal-motor system. We made focal neurobiotin injections into the midshipman PAG to both map its auditory-vocal circuitry and allow evolutionary comparisons with tetrapod vertebrates. These injections revealed an extensive bidirectional pattern of connectivity between the PAG and known sites in both the descending vocal-motor and the ascending auditory systems, including portions of the telencephalon, dorsal thalamus, hypothalamus, posterior tuberculum, midbrain, and hindbrain. Injections in the medial PAG produced dense label within hindbrain auditory nuclei, whereas those confined to the lateral PAG preferentially labeled hypothalamic and midbrain auditory areas. Thus, the teleost PAG may have functional subdivisions playing different roles in vocal-auditory integration. Together the results confirm several pathways previously identified by injections into known auditory or vocal areas and provide strong support for the hypothesis that the teleost PAG is centrally involved in auditory-vocal integration. PMID:22826153

  16. Quantitative autoradiography of TRH receptors and radioimmunoassay of TRH in the cat central nervous system

    SciTech Connect

    Bogin, R.M.; Kreider, M.S.; Caine, S.B.; Pack, A.I.; Winokur, A.

    1986-03-05

    In the cat, microinjection of Thyrotropin-Releasing Hormone (TRH) into certain areas of the central nervous system (CNS) changes ventilation and cardiovascular variables. To initiate a more systematic investigation of these effects, they undertook a study to determine the location of TRH and its receptors in the cat CNS. Using techniques previously described from the laboratory, quantitative autoradiograms for TRH receptors of the cat brain were produced; additional specimens were dissected, and radioimmunoassay for TRH was performed. Heterogeneous distribution of receptors was observed in the cat brain. In the forebrain, large quantities of TRH receptors were found in amygdala, hippocampus, claustrum, pyriform nucleus, and tuberculum olfactorium. In the brainstem, high concentrations were localized to the dorsal motor nucleus of the vagus, the hypoglossal nucleus, and the periaqueductal grey. The cerebellum contained few receptors. The largest quantities of the TRH tripeptide were noted in the hypothalamus and septum, with substantial amounts also obtained from the olfactory bulb, corpus striatum, and thalamus. The results demonstrate that the distribution of TRH and TRH receptors in the cat brain is very similar to that previously described in the rat and human brain. They provide a basis for exploring the physiological and pharmacological effects of TRH in cats.

  17. Association of 3D reconstruction and conventional radiography for the description of the appendicular skeleton of Chelonoidis carbonaria (Spix, 1824).

    PubMed

    Bortolini, Z; Lehmkuhl, R C; Ozeki, L M; Tranquilim, M V; Sesoko, N F; Teixeira, C R; Vulcano, L C

    2012-12-01

    In this study, we associated imaging modalities, such as computed tomography (CT) and standard radiography, with anatomical specimens to describe the anatomy of the appendicular skeleton of red-footed tortoises (Chelonoidis carbonaria), using animals of different sizes, ages, sexes and weights. Manus and pes bones were described from conventional radiography and osteological specimens, because they have small structures that could not be reconstructed. The main anatomical feature that differentiates C. carbonaria from others Testudines is the ischial-pubic tuberculum. The pectoral girdle is formed by the union of two bones, the scapula and the coracoid, showing no bone connection with the shell. Carpal and tarsal bones can be fused or not and include: carporadial and central carpus, carpoulnar and V carpal, central tarsal and fibular tarsal, distal tarsal I and II. The phalangeal formula is 2:2:2:2:2 in the forelimb and 2:2:2:2:1 in the hind limb. Imaging examinations are important tools in anatomical description and can be used in living individuals, replacing or aiding the study with anatomical specimens. PMID:22515213

  18. Differential regulation of the zebrafish orthopedia1 gene during fate determination of diencephalic neurons

    PubMed Central

    Del Giacco, Luca; Sordino, Paolo; Pistocchi, Anna; Andreakis, Nikos; Tarallo, Raffaella; Di Benedetto, Barbara; Cotelli, Franco

    2006-01-01

    Background The homeodomain transcription factor Orthopedia (Otp) is essential in restricting the fate of multiple classes of secreting neurons in the neuroendocrine hypothalamus of vertebrates. However, there is little information on the intercellular factors that regulate Otp expression during development. Results Here, we identified two otp orthologues in zebrafish (otp1 and otp2) and explored otp1 in the context of the morphogenetic pathways that specify neuroectodermal regions. During forebrain development, otp1 is expressed in anterior groups of diencephalic cells, positioned in the preoptic area (PO) (anterior alar plate) and the posterior tuberculum (PT) (posterior basal plate). The latter structure is characterized by Tyrosine Hydroxylase (TH)-positive cells, suggesting a role for otp1 in the lineage restriction of catecholaminergic (CA) neurons. Disruptions of Hedgehog (HH) and Fibroblast Growth Factor (FGF) pathways point to the ability of SHH protein to trigger otp1 expression in PO presumptive neuroblasts, with the attenuating effect of Dzip1 and FGF8. In addition, our data disclose otp1 as a determinant of CA neurons in the PT, where otp1 activity is strictly dependent on Nodal signaling and it is not responsive to SHH and FGF. Conclusion In this study, we pinpoint the evolutionary importance of otp1 transcription factor in cell states of the diencephalon anlage and early neuronal progenitors. Furthermore, our data indicate that morphogenetic mechanisms differentially regulate otp1 expression in alar and basal plates. PMID:17074092

  19. Morphological study of the lingual papillae of the giant panda (Ailuropoda melanoleuca) by scanning electron microscopy

    PubMed Central

    Pastor, J F; Barbosa, M; De Paz, F J

    2008-01-01

    Due to the scarcity of giant pandas, there are few descriptions of their morphology and even fewer of their microscopic anatomy and the ultrastructure of their organs. In this study of the complete tongue of an adult male giant panda, we describe the morphology of its lingual surface, the different types of papillae, their characteristics and topographic distribution. It was seen that there are four main types of lingual papillae: filiform, conical, fungiform and vallate. There was no sign of foliate papillae, tuberculum intermolare or sublingua. Papilla distribution was not limited to the dorsum of the tongue, but was also seen on the anterior and ventral surfaces of the tongue. In the anterior third of the midline there is a smooth area with no papillae at all. Morphology of the microgrooves and pores is similar to that observed in other mammals. The papillae share characteristics encountered in Carnivora and herbivorous species of mammals. A narrow bamboo-based diet and specialized manner of eating have together resulted in modification of the tongue of a carnivoran, giving it some characteristics typical of an herbivore. PMID:18254792

  20. Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria

    PubMed Central

    Mezue, Wilfred C; Ohaegbulam, Samuel C; Ndubuisi, Chika C; Chikani, Mark C; Achebe, David S

    2012-01-01

    Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM) mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare. PMID:23188985

  1. [Differentiation of human and nonhuman primate ribs].

    PubMed

    May, E; Martins, M

    1985-01-01

    The ribs of 9 human beings and 6 animal-primates (4 Pongidae and 2 Cercopithecidae of 2 different species) had been examined metrically with regard to their relative dimensions and proportions. Special care was taken as well of the differentiation of single ribs of one individual as of interspecific differentiation. Generally the Pongidae show the greatest relative-dimensions. This concerns both the diameter as the length. The individuals of the genus Homo have medium-sized dimensions, while the Cercopithecidae have the smallest. In this way a first grouping of the measurements becomes possible. As for the rib-diameter Homo concurs more with the Pongidae than with the Cercopithecidae. At first from the rib-proportions resulted an indication to special similarity between the Pongidae and recent man from whom the Cercopithecidae distinctively differ as it is shown by the indices angulus-sternal end/tuberculum-angulus. A divariate presentation of the measurements of this index, however, proves that Homo concerning the single measurements occupies an intermediate position between the Pongidae and the Cercopithecidae in this case, too (Fig. 5). The examination of the craniocaudal trend of different ribmeasurements (length, depth and area of the rib-arc) produced a special similarity of the 4 upper ribs between the Pongidae and Homo. In the region of the lower chest a great conformity between the Pongidae and the Cercopithecidae became obvious in this respect. A different trend shows up in Homo - probably as an expression of the transformation-process in the human chest. The intraspecific morphometric discrimination of the single ribs proves to be especially difficult, above all between the 7th to 10th rib, if the ribs of an individual are not completely present. It is, however, possible in some cases by means of some measurements and indices of these ribs. PMID:4083514

  2. Severe mental retardation with breathing abnormalities (Pitt-Hopkins syndrome) is caused by haploinsufficiency of the neuronal bHLH transcription factor TCF4.

    PubMed

    Brockschmidt, Antje; Todt, Unda; Ryu, Soojin; Hoischen, Alexander; Landwehr, Christina; Birnbaum, Stefanie; Frenck, Wilhelm; Radlwimmer, Bernhard; Lichter, Peter; Engels, Hartmut; Driever, Wolfgang; Kubisch, Christian; Weber, Ruthild G

    2007-06-15

    Pitt-Hopkins syndrome (PHS) is a rare syndromic mental disorder, which is mainly characterized by severe motor and mental retardation including absent language development, a characteristic facial gestalt and episodes of hyperventilation. We report on a female patient with PHS showing severe mental retardation with absent speech, pronounced muscular hypotonia, ataxia, distinctive facial features, such as a coarse face, a broad nasal bridge and a wide mouth, and hyperventilation attacks. In this patient, genomic profiling by array-based comparative genomic hybridization and fluorescence in situ hybridization studies detected and confirmed a de novo 0.5 Mb deletion in 18q21.2 containing a single gene, the basic helix-loop-helix transcription factor TCF4. cDNA and genomic analyses in the patient and her parents demonstrated TCF4 haploinsufficiency as the underlying cause of the disease. Analysis of the embryonal expression pattern of the Danio rerio ortholog, tcf4, by whole-mount in situ hybridization showed a highly specific expression domain in the pallium of the telencephalon during late somitogenesis, when the patterning of the zebrafish brain is advanced and neural differentiation commences. Later expression domains were restricted to several regions in the central nervous system, including continued expression in the pallium of the telencephalon, and starting expression in the diencephalon (thalamus, ventral thalamus and posterior tuberculum), the midbrain tegmentum, the hindbrain and the branchial arches. This expression pattern correlates with the clinical phenotype. Our results show that haploinsufficiency of TCF4 causes PHS and suggest that D. rerio is a valuable model to study the molecular pathogenesis of PHS and the role of TCF4 in brain development. PMID:17478476

  3. BDNF Expression in Larval and Adult Zebrafish Brain: Distribution and Cell Identification

    PubMed Central

    Cacialli, Pietro; Gueguen, Marie-Madeleine; Coumailleau, Pascal; D’Angelo, Livia; Kah, Olivier; Lucini, Carla; Pellegrini, Elisabeth

    2016-01-01

    Brain-derived neurotrophic factor (BDNF), a member of the neurotrophin family, has emerged as an active mediator in many essential functions in the central nervous system of mammals. BDNF plays significant roles in neurogenesis, neuronal maturation and/or synaptic plasticity and is involved in cognitive functions such as learning and memory. Despite the vast literature present in mammals, studies devoted to BDNF in the brain of other animal models are scarse. Zebrafish is a teleost fish widely known for developmental genetic studies and is emerging as model for translational neuroscience research. In addition, its brain shows many sites of adult neurogenesis allowing higher regenerative properties after traumatic injuries. To add further knowledge on neurotrophic factors in vertebrate brain models, we decided to determine the distribution of bdnf mRNAs in the larval and adult zebrafish brain and to characterize the phenotype of cells expressing bdnf mRNAs by means of double staining studies. Our results showed that bdnf mRNAs were widely expressed in the brain of 7 days old larvae and throughout the whole brain of mature female and male zebrafish. In adults, bdnf mRNAs were mainly observed in the dorsal telencephalon, preoptic area, dorsal thalamus, posterior tuberculum, hypothalamus, synencephalon, optic tectum and medulla oblongata. By combining immunohistochemistry with in situ hybridization, we showed that bdnf mRNAs were never expressed by radial glial cells or proliferating cells. By contrast, bdnf transcripts were expressed in cells with neuronal phenotype in all brain regions investigated. Our results provide the first demonstration that the brain of zebrafish expresses bdnf mRNAs in neurons and open new fields of research on the role of the BDNF factor in brain mechanisms in normal and brain repairs situations. PMID:27336917

  4. Exposure to Advertisement Calls of Reproductive Competitors Activates Vocal-Acoustic and Catecholaminergic Neurons in the Plainfin Midshipman Fish, Porichthys notatus

    PubMed Central

    Petersen, Christopher L.; Timothy, Miky; Kim, D. Spencer; Bhandiwad, Ashwin A.; Mohr, Robert A.; Sisneros, Joseph A.; Forlano, Paul M.

    2013-01-01

    While the neural circuitry and physiology of the auditory system is well studied among vertebrates, far less is known about how the auditory system interacts with other neural substrates to mediate behavioral responses to social acoustic signals. One species that has been the subject of intensive neuroethological investigation with regard to the production and perception of social acoustic signals is the plainfin midshipman fish, Porichthys notatus, in part because acoustic communication is essential to their reproductive behavior. Nesting male midshipman vocally court females by producing a long duration advertisement call. Females localize males by their advertisement call, spawn and deposit all their eggs in their mate’s nest. As multiple courting males establish nests in close proximity to one another, the perception of another male’s call may modulate individual calling behavior in competition for females. We tested the hypothesis that nesting males exposed to advertisement calls of other males would show elevated neural activity in auditory and vocal-acoustic brain centers as well as differential activation of catecholaminergic neurons compared to males exposed only to ambient noise. Experimental brains were then double labeled by immunofluorescence (-ir) for tyrosine hydroxylase (TH), an enzyme necessary for catecholamine synthesis, and cFos, an immediate-early gene product used as a marker for neural activation. Males exposed to other advertisement calls showed a significantly greater percentage of TH-ir cells colocalized with cFos-ir in the noradrenergic locus coeruleus and the dopaminergic periventricular posterior tuberculum, as well as increased numbers of cFos-ir neurons in several levels of the auditory and vocal-acoustic pathway. Increased activation of catecholaminergic neurons may serve to coordinate appropriate behavioral responses to male competitors. Additionally, these results implicate a role for specific catecholaminergic neuronal groups

  5. Exposure to advertisement calls of reproductive competitors activates vocal-acoustic and catecholaminergic neurons in the plainfin midshipman fish, Porichthys notatus.

    PubMed

    Petersen, Christopher L; Timothy, Miky; Kim, D Spencer; Bhandiwad, Ashwin A; Mohr, Robert A; Sisneros, Joseph A; Forlano, Paul M

    2013-01-01

    While the neural circuitry and physiology of the auditory system is well studied among vertebrates, far less is known about how the auditory system interacts with other neural substrates to mediate behavioral responses to social acoustic signals. One species that has been the subject of intensive neuroethological investigation with regard to the production and perception of social acoustic signals is the plainfin midshipman fish, Porichthys notatus, in part because acoustic communication is essential to their reproductive behavior. Nesting male midshipman vocally court females by producing a long duration advertisement call. Females localize males by their advertisement call, spawn and deposit all their eggs in their mate's nest. As multiple courting males establish nests in close proximity to one another, the perception of another male's call may modulate individual calling behavior in competition for females. We tested the hypothesis that nesting males exposed to advertisement calls of other males would show elevated neural activity in auditory and vocal-acoustic brain centers as well as differential activation of catecholaminergic neurons compared to males exposed only to ambient noise. Experimental brains were then double labeled by immunofluorescence (-ir) for tyrosine hydroxylase (TH), an enzyme necessary for catecholamine synthesis, and cFos, an immediate-early gene product used as a marker for neural activation. Males exposed to other advertisement calls showed a significantly greater percentage of TH-ir cells colocalized with cFos-ir in the noradrenergic locus coeruleus and the dopaminergic periventricular posterior tuberculum, as well as increased numbers of cFos-ir neurons in several levels of the auditory and vocal-acoustic pathway. Increased activation of catecholaminergic neurons may serve to coordinate appropriate behavioral responses to male competitors. Additionally, these results implicate a role for specific catecholaminergic neuronal groups in

  6. Distribution of galanin receptor 2b neurons and interaction with galanin in the zebrafish central nervous system.

    PubMed

    Kim, Eunmi; Jeong, Inyoung; Kim, Suhyun; Kim, Hwan-Ki; Lee, Dong-Won; Kim, Boa; Seong, Jae Young; Bae, Young-Ki; Ryu, Jae-Ho; Park, Hae-Chul

    2016-08-15

    Galanin is a multifunctional neuropeptide that is implicated in the modulation of physiological processes, including nociception, cognition, feeding behavior, neuronal growth, and reproduction. The physiological effects of galanin are mediated through its interaction with three different G protein-coupled receptors, i.e., GALR1, GALR2, and GALR3. Unlike mammals, zebrafish have four different receptors for galanin, diversified from GALR1 (GAL1a and GALR1b) and GALR2 (GALR2a and GALR2b). Despite the importance of galanin in the central nervous system (CNS), no information has been reported regarding GalR2 in zebrafish CNS. In this study, we found that galr2a is expressed at low levels in restricted areas of the brain; however, galr2b was widely expressed in CNS including olfactory bulb, midbrain tegmentum, preoptic region, dorsal thalamus, posterior tuberculum, postoptic commissure, hindbrain, and spinal cord. To further analyze the distribution of GALR2b neurons and their interaction with GAL, we generated Tg(galr2b:egfp) zebrafish, which express enhanced green fluorescent protein (EGFP) under the control of a galr2b promoter. Investigation of the CNS of transgenic reporter zebrafish revealed that galr2b:EGFP(+) neurons are distributed and interact with galanin-immunoreactive (galanin-IR) cells in various regions of the brain and spinal cord. We found that in some regions of the brain and spinal cord, galanin-IR nerve cells were not observed near galr2b:EGFP neurons, suggesting that GALR2b may have the potential to interact with other ligands instead of galanin in these regions. PMID:27315774

  7. Evolutionarily conserved organization of the dopaminergic system in lamprey: SNc/VTA afferent and efferent connectivity and D2 receptor expression.

    PubMed

    Pérez-Fernández, Juan; Stephenson-Jones, Marcus; Suryanarayana, Shreyas M; Robertson, Brita; Grillner, Sten

    2014-12-01

    The dopaminergic system influences motor behavior, signals reward and novelty, and is an essential component of the basal ganglia in all vertebrates including the lamprey, one of the phylogenetically oldest vertebrates. The intrinsic organization and function of the lamprey basal ganglia is highly conserved. For instance, the direct and indirect pathways are modulated through dopamine D1 and D2 receptors in lamprey and in mammals. The nucleus of the tuberculum posterior, a homologue of the substantia nigra pars compacta (SNc)/ventral tegmental area (VTA) is present in lamprey, but only scarce data exist about its connectivity. Likewise, the D2 receptor is expressed in the striatum, but little is known about its localization in other brain areas. We used in situ hybridization and tracer injections, both in combination with tyrosine hydroxylase immunohistochemistry, to characterize the SNc/VTA efferent and afferent connectivity, and to relate its projection pattern with D2 receptor expression in particular. We show that most features of the dopaminergic system are highly conserved. As in mammals, the direct pallial (cortex in mammals) input and the basal ganglia connectivity with the SNc/VTA are present as part of the evaluation system, as well as input from the tectum as the evolutionary basis for salience/novelty detection. Moreover, the SNc/VTA receives sensory information from the olfactory bulbs, optic tectum, octavolateral area, and dorsal column nucleus, and it innervates, apart from the nigrostriatal pathway, several motor-related areas. This suggests that the dopaminergic system also contributes to the control of different motor centers at the brainstem level. PMID:24942187

  8. Catecholaminergic connectivity to the inner ear, central auditory and vocal motor circuitry in the plainfin midshipman fish, Porichthys notatus

    PubMed Central

    Forlano, Paul M.; Kim, Spencer D.; Krzyminska, Zuzanna M.; Sisneros, Joseph A.

    2014-01-01

    Although the neuroanatomical distribution of catecholaminergic (CA) neurons has been well documented across all vertebrate classes, few studies have examined CA connectivity to physiologically and anatomically identified neural circuitry that controls behavior. The goal of this study was to characterize CA distribution in the brain and inner ear of the plainfin midshipman fish (Porichthys notatus) with particular emphasis on their relationship with anatomically labeled circuitry that both produces and encodes social acoustic signals in this species. Neurobiotin labeling of the main auditory endorgan, the saccule, combined with tyrosine hydroxylase immunofluorescence (TH-ir) revealed a strong CA innervation of both the peripheral and central auditory system. Diencephalic TH-ir neurons in the periventricular posterior tuberculum, known to be dopaminergic, send ascending projections to the ventral telencephalon and prominent descending projections to vocal-acoustic integration sites, notably the hindbrain octavolateralis efferent nucleus, as well as onto the base of hair cells in the saccule via nerve VIII. Neurobiotin backfills of the vocal nerve in combination with TH-ir revealed CA terminals on all components of the vocal pattern generator which appears to largely originate from local TH-ir neurons but may include diencephalic projections as well. This study provides strong evidence for catecholamines as important neuromodulators of both auditory and vocal circuitry and acoustic-driven social behavior in midshipman fish. This first demonstration of TH-ir terminals in the main endorgan of hearing in a non-mammalian vertebrate suggests a conserved and important anatomical and functional role for dopamine in normal audition. PMID:24715479

  9. LPXRFa peptide system in the European sea bass: A molecular and immunohistochemical approach.

    PubMed

    Paullada-Salmerón, José A; Cowan, Mairi; Aliaga-Guerrero, María; Gómez, Ana; Zanuy, Silvia; Mañanos, Evaristo; Muñoz-Cueto, José A

    2016-01-01

    Gonadotropin-inhibitory hormone (GnIH) is a neuropeptide that suppresses reproduction in birds and mammals by inhibiting GnRH and gonadotropin secretion. GnIH orthologs with a C-terminal LPXRFamide (LPXRFa) motif have been identified in teleost fish. Although recent work also suggests its role in fish reproduction, studies are scarce and controversial, and have mainly focused on cyprinids. In this work we cloned a full-length cDNA encoding an LPXRFa precursor in the European sea bass, Dicentrarchus labrax. In contrast to other teleosts, the sea bass LPXRFa precursor contains only two putative RFamide peptides, termed sbLPXRFa1 and sbLPXRFa2. sblpxrfa transcripts were expressed predominantly in the olfactory bulbs/telencephalon, diencephalon, midbrain tegmentum, retina, and gonads. We also developed a specific antiserum against sbLPXRFa2, which revealed sbLPXRFa-immunoreactive (ir) perikarya in the olfactory bulbs-terminal nerve, ventral telencephalon, caudal preoptic area, dorsal mesencephalic tegmentum, and rostral rhombencephalon. These sbLPXRFa-ir cells profusely innervated the preoptic area, hypothalamus, optic tectum, semicircular torus, and caudal midbrain tegmentum, but conspicuous projections also reached the olfactory bulbs, ventral/dorsal telencephalon, habenula, ventral thalamus, pretectum, rostral midbrain tegmentum, posterior tuberculum, reticular formation, and viscerosensory lobe. The retina, pineal, vascular sac, and pituitary were also targets of sbLPXRFa-ir cells. In the pituitary, this innervation was observed close to follicle-stimulating hormone (FSH), luteinizing hormone (LH) and growth hormone (GH) cells. Tract-tracing retrograde labeling suggests that telencephalic and preoptic sbLPXRFa cells might represent the source of pituitary innervation. The immunohistochemical distribution of sbLPXRFa cells and fibers suggest that LPXRFa peptides might be involved in some functions as well as reproduction, such as feeding, growth, and behavior. PMID

  10. Comparative evaluation of the effects of short-term inhalation exposure to diesel engine exhaust on rat lung and brain

    PubMed Central

    van Berlo, Damien; Albrecht, Catrin; Knaapen, Ad M.; Cassee, Flemming R.; Gerlofs-Nijland, Miriam E.; Kooter, Ingeborg M.; Palomero-Gallagher, Nicola; Bidmon, Hans-Jürgen; van Schooten, Frederik-Jan; Krutmann, Jean

    2010-01-01

    Combustion-derived nanoparticles, such as diesel engine exhaust particles, have been implicated in the adverse health effects of particulate air pollution. Recent studies suggest that inhaled nanoparticles may also reach and/or affect the brain. The aim of our study was to comparatively evaluate the effects of short-term diesel engine exhaust (DEE) inhalation exposure on rat brain and lung. After 4 or 18 h recovery from a 2 h nose-only exposure to DEE (1.9 mg/m3), the mRNA expressions of heme oxygenase-1 (HO-1), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and cytochrome P450 1A1 (CYP1A1) were investigated in lung as well as in pituitary gland, hypothalamus, olfactory bulb, olfactory tubercles, cerebral cortex, and cerebellum. HO-1 protein expression in brain was investigated by immunohistochemistry and ELISA. In the lung, 4 h post-exposure, CYP1A1 and iNOS mRNA levels were increased, while 18 h post-exposure HO-1 was increased. In the pituitary at 4 h post-exposure, both CYP1A1 and HO-1 were increased; HO-1 was also elevated in the olfactory tuberculum at this time point. At 18 h post-exposure, increased expression of HO-1 and COX-2 was observed in cerebral cortex and cerebellum, respectively. Induction of HO-1 protein was not observed after DEE exposure. Bronchoalveolar lavage analysis of inflammatory cell influx, TNF-α, and IL-6 indicated that the mRNA expression changes occurred in the absence of lung inflammation. Our study shows that a single, short-term inhalation exposure to DEE triggers region-specific gene expression changes in rat brain to an extent comparable to those observed in the lung. PMID:20467864

  11. Forebrain dopamine neurons project down to a brainstem region controlling locomotion

    PubMed Central

    Ryczko, Dimitri; Grätsch, Swantje; Auclair, François; Dubé, Catherine; Bergeron, Saskia; Alpert, Michael H.; Cone, Jackson J.; Roitman, Mitchell F.; Alford, Simon; Dubuc, Réjean

    2013-01-01

    The contribution of dopamine (DA) to locomotor control is traditionally attributed to ascending dopaminergic projections from the substantia nigra pars compacta and the ventral tegmental area to the basal ganglia, which in turn project down to the mesencephalic locomotor region (MLR), a brainstem region controlling locomotion in vertebrates. However, a dopaminergic innervation of the pedunculopontine nucleus, considered part of the MLR, was recently identified in the monkey. The origin and role of this dopaminergic input are unknown. We addressed these questions in a basal vertebrate, the lamprey. Here we report a functional descending dopaminergic pathway from the posterior tuberculum (PT; homologous to the substantia nigra pars compacta and/or ventral tegmental area of mammals) to the MLR. By using triple labeling, we found that dopaminergic cells from the PT not only project an ascending pathway to the striatum, but send a descending projection to the MLR. In an isolated brain preparation, PT stimulation elicited excitatory synaptic inputs into patch-clamped MLR cells, accompanied by activity in reticulospinal cells. By using voltammetry coupled with electrophysiological recordings, we demonstrate that PT stimulation evoked DA release in the MLR, together with the activation of reticulospinal cells. In a semi-intact preparation, stimulation of the PT elicited reticulospinal activity together with locomotor movements. Microinjections of a D1 antagonist in the MLR decreased the locomotor output elicited by PT stimulation, whereas injection of DA had an opposite effect. It appears that this descending dopaminergic pathway has a modulatory role on MLR cells that are known to receive glutamatergic projections and promotes locomotor output. PMID:23918379

  12. DeltaA/DeltaD regulate multiple and temporally distinct phases of notch signaling during dopaminergic neurogenesis in zebrafish.

    PubMed

    Mahler, Julia; Filippi, Alida; Driever, Wolfgang

    2010-12-01

    Dopaminergic neurons develop at distinct anatomical sites to form some of the major neuromodulatory systems in the vertebrate brain. Despite their relevance in neurodegenerative diseases and the interests in reconstitutive therapies from stem cells, mechanisms of the neurogenic switch from precursor populations to dopaminergic neurons are not well understood. Here, we investigated neurogenesis of different dopaminergic and noradrenergic neuron populations in the zebrafish embryo. Birth-dating analysis by EdU (5-ethynyl-2'-deoxyuridine) incorporation revealed temporal dynamics of catecholaminergic neurogenesis. Analysis of Notch signaling mutants and stage-specific pharmacological inhibition of Notch processing revealed that dopaminergic neurons form by temporally distinct mechanisms: dopaminergic neurons of the posterior tuberculum derive directly from neural plate cells during primary neurogenesis, whereas other dopaminergic groups form in continuous or wavelike neurogenesis phases from proliferating precursor pools. Systematic analysis of Notch ligands revealed that the two zebrafish co-orthologs of mammalian Delta1, DeltaA and DeltaD, control the neurogenic switch of all early developing dopaminergic neurons in a partially redundant manner. DeltaA/D may also be involved in maintenance of dopaminergic precursor pools, as olig2 expression in ventral diencephalic dopaminergic precursors is affected in dla/dld mutants. DeltaA/D act upstream of sim1a and otpa during dopaminergic specification. However, despite the fact that both dopaminergic and corticotropin-releasing hormone neurons derive from sim1a- and otpa-expressing precursors, DeltaA/D does not act as a lineage switch between these two neuronal types. Rather, DeltaA/D limits the size of the sim1a- and otpa-expressing precursor pool from which dopaminergic neurons differentiate. PMID:21148001

  13. [Nailing of inter- and subtrochanteric fractures - operative technique].

    PubMed

    Douša, P; Skála-Rosenbaum, J

    2013-10-01

    Intertrochanteric and subtrochanteric fractures are a quite heterogeneous and imprecisely defined group of fractures. These fractures can be essentially divided into two basic groups. The first one belongs to trochanteric fractures. In the AO/ASIF classification; these fractures are called intertrochanteric (31A3). In the second group, the term subtrochanteric fracture is used by most authors for fractures about 5 cm distally from lesser trochanter. In both intertrochanteric and subtrochanteric fractures, the proximal fragment is formed by femoral head, neck and greater trochanter including its base with vastus ridge (tuberculum vastoadductorium or innominate tubercle). On this tubercle, the gluteus medius muscle (proximally) and the origin of the vastus lateralis muscle (distally) are attached. Tension of these muscles may cause dislocation of the proximal fragment. For this reason, reduction of the fracture can be troublesome and it is more difficult than in pertrochanteric fractures It seems that intramedullary nailing will remain the favorite technique of most of the surgeons dealing with intertrochanteric and subtrochanteric fractures. We use short reconstruction nail in intertrochanteric fractures. It is useful to use long reconstruction nail in subtrochanteric fractures. Distal locking of the nail is necessary. Dynamic distal locking is preferred because the two main fragments are compressed along the axis of the nail. The number of complications was largely related to technical errors, such as insufficient reduction or an incorrectly inserted implant. No implant can compensate for errors due to surgery. Serious complications can be reduced by the correct assessment of fracture type, the use of an appropriate operative technique and early treatment of potential complications. The necessity of restoring continuity in the medial cortex of the femoral neck (Adams arch) is the requirement that should be observed. Pseudoarthrosis or varus malalignment in a healed