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Sample records for sellae tuberculum sellae

  1. Penetration and Splitting of Optic Nerve by Tuberculum Sellae Meningioma

    PubMed Central

    Park, Seong-Cheol

    2016-01-01

    Preservation of the optic nerves is an important issue in the resection of tuberculum sellae meningiomas. We report the case of a patient whose optic nerve was penetrated by a tuberculum sellae meningioma. During surgery, a bulging tumor was found to penetrate the right optic nerve. The tumor was gross totally removed, including tumors bulging through the optic nerve. Two trunks of the split optic nerve were preserved. The penetrated shape of the optic nerve may lead to misjudgment and its damage. Divided trunks of optic nerves are difficult to recognize and may be confused for the tumor capsule, because they may be thinned and seem to contain tumors. In addition, a single trunk may be confused for the whole nerve; thus, the other trunk may be easily damaged if not dissected cautiously. Treatment strategy according to the remnant visual acuity was suggested. PMID:27651874

  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. Endoscopic endonasal transsphenoidal approach for resection of a coexistent pituitary macroadenoma and a tuberculum sellae meningioma

    PubMed Central

    Mahvash, Mehran; Igressa, Ahadi; Pechlivanis, Ioannis; Weber, Friedrich; Charalampaki, Patra

    2014-01-01

    The coexistence of a pituitary macroadenoma and a tuberculum sellae meningioma is very rare. This article demonstrates the surgical technique of the simultaneous resection of a pituitary macroadenoma and a tuberculum sellae meningioma using an endoscopic, endonasal, biportal, transsphenoidal approach. A 36-year-old woman presented with frontal headache and extended visual field loss of the right eye. She underwent cranial magnetic resonance imaging (MRI) revealing a 2 × 2 × 2.5 mm contrast-enhancing intrasellar and suprasellar lesion with compression of the optic chiasma. The coexistence of a pituitary macroadenoma and meningioma was suggested. A biportal endoscopic endonasal transsphenoidal approach was performed to remove both lesions. The histological results confirmed the coexistence of the pituitary macroadenoma and meningioma, World Health Organization (WHO) grade I. The endoscopic, endonasal, transsphenoidal approach is a safe and reliable minimal invasive surgical alternative for resection of the intra-, supra- and parasellar lesions, avoiding additional craniotomy. PMID:25685225

  4. Endoscopic transnasal surgery for planum and tuberculum sella meningiomas: decision-making, technique and outcomes.

    PubMed

    Kshettry, Varun R; Elshazly, Khaled; Evans, James J

    2016-10-01

    Tuberculum sella and planum sphenoidale meningiomas pose a management challenge given their intimate relationship to surrounding critical neurovascular structures. The development and advancement of expanded endoscopic transnasal surgery has provided a good surgical option that in well-selected cases, may provide several advantages over a transcranial route. These include early devascularization, complete dura and bone removal, elimination of brain retraction and enhanced visualization of the optic apparatus perforating vessels. The authors review the endoscopic transnasal approach to these tumors and discuss surgical decision-making and case selection, surgical technique and outcomes. We also discuss the expanding role of stereotactic radiosurgery and fractionated stereotactic radiotherapy for these challenging lesions.

  5. Endoscopic transnasal surgery for planum and tuberculum sella meningiomas: decision-making, technique and outcomes.

    PubMed

    Kshettry, Varun R; Elshazly, Khaled; Evans, James J

    2016-10-01

    Tuberculum sella and planum sphenoidale meningiomas pose a management challenge given their intimate relationship to surrounding critical neurovascular structures. The development and advancement of expanded endoscopic transnasal surgery has provided a good surgical option that in well-selected cases, may provide several advantages over a transcranial route. These include early devascularization, complete dura and bone removal, elimination of brain retraction and enhanced visualization of the optic apparatus perforating vessels. The authors review the endoscopic transnasal approach to these tumors and discuss surgical decision-making and case selection, surgical technique and outcomes. We also discuss the expanding role of stereotactic radiosurgery and fractionated stereotactic radiotherapy for these challenging lesions. PMID:27671322

  6. 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.

  7. Empty sella syndrome

    MedlinePlus

    ... pituitary gland. Prolactin stimulates breast development and milk production in women. Complications of secondary empty sella syndrome are related to the cause of pituitary gland disease or to the effects of too little pituitary hormone.

  8. From above or below: the controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches.

    PubMed

    Soni, Resha S; Patel, Smruti K; Husain, Qasim; Dahodwala, Mufaddal Q; Eloy, Jean Anderson; Liu, James K

    2014-04-01

    In the early 20th century, the first successful surgical removal of a tuberculum sellae meningioma (TSM) was performed and described by Harvey Cushing. It soon became recognized that TSM pose a formidable challenge for skull base surgeons because of their deep and sensitive location, proximity to critical neurovascular elements, and often dense and fibrous nature. Because of this, over the next several decades controversy transpired regarding their optimal method of resection. Early attempts involved utilization of open transcranial routes. This included classic bilateral and unilateral frontal approaches, followed by pterional or frontotemporal approaches, which have evolved to incorporate skull base modifications, such as the supraorbital, orbitozygomatic, and orbitopterional approaches. Minimally invasive supraorbital keyhole approaches through eyebrow incisions have also been adopted. Over the past 25 years, the microsurgical transsphenoidal approach, classically used for pituitary and parasellar tumors, was modified to resect suprasesllar TSM via the extended transsphenoidal approach. More recently, with the evolution of endoscopic techniques, resection of TSM has been achieved using purely endoscopic endonasal transplanum transtuberculum approaches. Although each of these techniques has been successfully described for the treatment of TSM, the question still remains: is it better to access and operate on these lesions via a traditional, transcranial avenue, or are they better treated via endoscopic endonasal techniques? We outline the surgical management of TSM through history, from early transcranial and transsphenoidal approaches to modern extended endoscopic endonasal procedures. We briefly explore the arguments favoring each of the methods and the advancements which have emerged to further optimize surgical resection. PMID:24231561

  9. Empty sella syndrome.

    PubMed

    Lenz, Anne M; Root, Allen W

    2012-08-01

    An empty sella (ES) develops when cerebrospinal fluid (CSF) fills the sella turcica and compresses pituitary tissue until it lines the sellar floor and walls. Primary ES occurs when CSF enters the sella through a rent in the sellar diaphragm that may or may not be associated with increased intracranial pressure. Secondary ES is a result of an injury to the pituitary itself (e.g., pituitary apoplexy) or the consequence of surgical or radiation treatment. In adults, ES is most commonly found in older, obese, hypertensive, multiparous women and may be asymptomatic. In children, however, ES is more likely to be associated with clinical symptoms and endocrinopathies, particularly growth hormone deficiency, hypogonadotropism, or multiple pituitary hormone deficiencies. The incidence of ES in children varies greatly depending on the population surveyed, ranging from 1.2% (children without endocrine symptoms) to 68% (children with known endocrinopathy). Children with a finding of ES require endocrinologic and ophthalmologic evaluation. Treatment of ES includes replacement of hormone deficiencies and occasionally surgical measures to relieve obstructive intracranial lesions.

  10. 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

  11. [Endocrine disorders in "empty" sella turcica].

    PubMed

    Mizetskaia, E A; Snigireva, R Ia

    1984-01-01

    The results of endocrine examination of 37 patients with an "empty" sella turcica (22 with primary and 15 with secondary) are discussed. The diagnosis in all cases was verified by the findings of pneumocisternotomography and computer-aided tomography. The trophic function of the hypophysis was mainly studied. It was found that primary "empty" sella turcica mostly occurs in females with a history of many pregnancies. Obesity and disorders of menstrual function were the principal clinical manifestations of endocrine disorders. The inconstantly encountered moderate hyperprolactinemia disappeared after parlodel medication. In secondary "empty" sella turcica hyperprolactinemia was of a more stable character. The trophic function of the hypophysis was reduced in primary "empty" sella turcica as a result of which lesser doses of substitutive hormonal preparations were needed than in secondary "empty" sella turcica. The endocrine disorders in primary "empty" sella turcica were probably of hypothalamic origin, those in a secondary condition were evidently associated with a tumor of the adenohypophysis. PMID:6528785

  12. 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

  13. 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

  14. 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

  15. Secondary partial empty sella syndrome in an elite bodybuilder.

    PubMed

    Dickerman, R D; Jaikumar, S

    2001-06-01

    The pituitary gland is a hormone-responsive gland and is known to vary in size depending on the hormonal status of the patient and the multifaceted positive and negative feedback hypothalamic-pituitary-gonadal axis. Partial empty sella syndrome with an atrophied pituitary gland is seen in primary neuroendocrinopathies such as growth hormone deficiency, primary hypothyroidism, central diabetes insipidus and hypogonadism. Partial empty sella has also been shown to occur in patients with elevations in intracranial pressure. Secondary partial empty sella syndrome with significant pituitary gland atrophy from negative feedback inhibition of long-term exogenous hormonal use has not been previously reported. We are reporting on a case of partial empty sella syndrome occurring in an elite bodybuilder with a long history of exogenous abuse of growth hormone, testosterone and thyroid hormone. The pathophysiological mechanisms of secondary partial empty sella syndrome from exogenous hormone use and the possibility for elevations in intracranial pressure contributing to this syndrome will be discussed.

  16. [Primary empty sella. Clinico-radiologic considerations in 18 cases].

    PubMed

    Pompili, A; Jachetti, M; Carapella, C M; Crecco, M; Gaudino, G; Isabella, F; Mastrostefano, R

    1985-01-28

    18 patients with "primary empty sella" were reviewed for this study. In 3 of them the sellar enlargement was discovered occasionally by performing skull radiographs for other reasons. The galattorrhea-dismenorrhea or amenorrhea syndrome and obesity were the most common clinical features. Endocrinological tests were normal in ten patients and abnormal in eight. Slight elevation of serum PRL was the most common record. 12 patients had enlarging of the sella turcica; in 4, only the floor was asymmetric and in 2 the sella was quite normal. In 5 patients C.T. without intra-thecal contrast was sufficient to discover the E.S. In 13 patients we performed C.T. cysternography by injecting in the lumbar subarachnoid space 8-10 ml of Iopamidolo 200. This is an excellent and safe technique to perform C.T. cysternography.

  17. [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.

  18. Ectopic prolactinoma within the sphenoidal sinus associated with empty sella

    PubMed Central

    Ajler, Pablo; Bendersky, Damián; Hem, Santiago; Campero, Alvaro

    2012-01-01

    Background: Pituitary adenomas are a common cause of endocrinal dysfunction, which comprise 10–20% of all intracranial tumors. Although almost all of them arise within the sella turcica, there are some rare cases in which a pituitary adenoma is located outside the intrasellar region, so it is defined as an ectopic pituitary adenoma (EPA). Case Description: We described a case of a 31-year-old male with a serum prolactin (PRL) value of 240 ng/ml Magnetic resonance imaging (MRI) showed a space-occupying mass within the sphenoid sinus (SS) which partially enhanced by gadolinium. MRI did not reveal any sellar floor defect and an empty sella was detected. As dopamine agonist treatment had failed in lowering the serum PRL level, he underwent surgical treatment. A transsphenoidal approach without opening the sellar floor was performed using an operating microscope and the lesion within the SS was completely removed. Conclusion: Although intrasphenoidal EPAs are rare findings, the presence of an endocrine disorder related to pituitary hormones, and a space-occupying mass within the SS associated with either a normal sellar pituitary gland or an empty sella must lead us to suspect this diagnosis. PMID:22629484

  19. 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

  20. Empty sella in children and adolescents with possible hypothalamic-pituitary disorders.

    PubMed

    Cacciari, E; Zucchini, S; Ambrosetto, P; Tani, G; Carlà, G; Cicognani, A; Pirazzoli, P; Sganga, T; Balsamo, A; Cassio, A

    1994-03-01

    Several computed tomographic scan studies have described empty sellae in children with hypothalamic-pituitary disorders. Magnetic resonance imaging, however, is a more precise technique for visualizing the intrasellar content, such as the stalk and pituitary lobes. Using magnetic resonance imaging, we studied 339 children and adolescents (mean age +/- SD, 12.7 +/- 4.5 yr) with possible hypothalamic-pituitary disorders to ascertain the frequency of primary empty sella and examine its relationships with other intrasellar abnormalities, pituitary function, and adverse perinatal events. One hundred and ninety-three patients had isolated GH deficiency, 43 had multiple pituitary hormone deficiency, 10 had diabetes insipidus, 17 had hypogonadotropic hypogonadism, 5 had idiopathic delayed puberty, 47 had precocious puberty, and 24 had other hypothalamic pituitary disorders of hyperfunction. One tenth (10.9%) of the patients (37 cases) had empty sella, with a marked variation of incidences among the disorders listed above. A statistically higher frequency of subjects with empty sellae was found only in patients with multiple pituitary hormone deficiency. Patients with and without empty sellae were not different in regard to age or sex. The incidence of empty sella in the various groups of patients was as follows: isolated GH deficiency, 8.8% (17 cases); multiple pituitary hormone deficiency, 34.9% (15 cases); hypogonadotropic hypogonadism, 5.9% (1 case); idiopathic delayed puberty, 40% (2 cases); and precocious puberty, 4.2% (2 cases). No patients with isolated diabetes insipidus or other hypothalamic-pituitary disorders had empty sellae. In the patients with empty sellae, abnormalities of the stalk or posterior lobe were found in 1 patient with isolated GH deficiency (5.9%), 13 patients with multiple pituitary hormone deficiency (86.7%), and no patients with puberty disorders. Likewise, adverse perinatal events were found only in 1 patient with isolated GH deficiency and 9

  1. Chondroid chordoma of the sella turcica mimicking a pituitary adenoma.

    PubMed

    Wu, Arthur W; Bhuta, Sunita; Salamon, Noriko; Martin, Neil; Wang, Marilene B

    2015-01-01

    We report an unusual case of a chondroid chordoma of the sella turcica that mimicked the clinical and radiologic presentation of the more common pituitary adenoma. A 50-year-old man presented with bitemporal visual field deficits. Magnetic resonance imaging (MRI) detected a sellar mass that was suggestive of a pituitary adenoma. However, the intraoperative appearance of the mass was not consistent with an adenoma, and frozen-section pathology was obtained. Pathology identified the mass as a malignant lesion. Based on this finding, the mass was treated more aggressively. Chondroid chordomas are rare and slowly growing but locally aggressive tumors. The prognosis depends on the ability to totally resect the mass, so differentiating this tumor from a benign lesion is critical. An intrasellar chordoma can be confused clinically and radiologically with a pituitary adenoma. These two lesions are nearly identical on MRI, although T2-weighted imaging sometimes demonstrates higher intensity with a chondroid chordoma. Computed tomography may be helpful in demonstrating bony destruction by these lesions, as can the presence of intralesional calcifications. Intraoperative findings of bony invasion or a purple-red color may also lead the surgeon to suspect a diagnosis other than pituitary adenoma.

  2. [Primary empty sella syndrome. Observations on 71 cases].

    PubMed

    Bianconcini, G; Bragagni, G; Bianconcini, M

    1999-02-01

    Primary empty sella syndrome (ESS) is an anatomo-radiological picture characterized by the presence of an arachnoid herniation filled with liquor that compresses the pituitary against the sellar wall. ESS occurs particularly in obese, hypertensive, cephalgic women, it is often asymptomatic but it may be associated with ophthalmologic, neurologic and sometime non-characterizing endocrine disorders. We report here 71 cases of primary ESS observed and assessed during the last fourteen years. The following endocrinological diagnostic procedures were carried out: hormonal (RIA) basal profile: FT3, FT4, TSH, PRL, ACTH, FSH, LH, 8.00 a.m. and p.m. cortisolemia, Aldo, PRA, DHEA-S, FTe, E2, P, PTH, CT, and calcemia and phosphoremia; provocative tests: TRH, GnRH, insulin hypoglycemia, etc.; inhibition tests: "overnight" and high dose dexamethasone. Clinical, radiological (skull radiographs, CT and/or MRI) and ophthalmologic (fundus, visual fields) assessment were made. We found principally cephalgia (52/71: 73.2%), hypertension (42/71: 59.1%), obesity (47/71: 66.1%). But we found especially mental disorders (57/71: 80.2%), in our knowledge not previously reported in the literature, as anxiety or dysthymic disorders with behavioural disturbances (chiefly oral compulsion). We found endocrinopathies in 36/71 (50.7%), isolated or coexisting in some patients: hyperPRL (14%), hypopituitarism (10.4%), hypogonadism (7%), diabetes insipidus (2.8%), hyperACTH (1.4%), hypoGH (15.4%), pituitary adenomas (8.4%). Several hypothalamic illness show a clinical picture including mental disorders and obesity. The Authors hypothesize that the ESS may be a "new" hypothalamic syndrome (compression/stretching on hypophysis and/or hypophyseal stalk by arachnoidocele; disorder of some hormones and neurotransmitters as leptin, neuropeptide Y, orexins, POMC-derived peptides, etc).

  3. Painful ophthalmoplegia secondary to a mucocele involving the sella turcica, superior orbital fissure, and sphenoid sinus.

    PubMed

    Clarke, H; Clarke, V; Gill, J; St John, A; Lashley, M

    1992-03-01

    A case of painful ophthalmoplegia associated with an extensive lesion involving the sella turcica, superior orbital fissure, and sphenoid sinus in a 57-year-old man is reported. Even though nasal and ocular symptoms and signs represent the usual features of sphenoidal mucoceles, extension to the intracranial cavity as seen in this lesion is rare. Surgical exploration via a sublabial, transseptal approach revealed a mucocele of the sphenoid sinus. This case exhibited extensive and aggressive behavior simulating a malignant neoplasm.

  4. 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

  5. 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

  6. Sella turcica morphology and the pituitary gland-a new contribution to craniofacial diagnostics based on histology and neuroradiology.

    PubMed

    Kjær, Inger

    2015-02-01

    The present review summarizes two decades of published and unpublished studies on normal and pathological development of sella turcica and pituitary gland in humans. The pathological conditions are studied in known genotype deviations, syndromes, and other malformations. The studies include histological analyses of human prenatal material and profile radiographic analyses of human postnatal material, supplemented in a few cases with neuroradiology. Prenatal and postnatal results are compared. Similarities between prenatal and postnatal deviations in sella turcica morphology were demonstrated. Malformations in the pituitary gland were observed in several cases. For diagnostic purposes, the review distinguishes between deviations in the anterior wall and in the posterior wall of the sella turcica. Deviations in the anterior wall seem to be associated with deviations specifically in the frontonasal developmental field, while deviations in the posterior wall are often connected with malformations in the posterior structures, e.g. the cerebellum. In normal cases, minor variations in morphology are observed. In each pathological case, a specific malformation pattern was observed in sella turcica morphology, varying from mild to severe phenotype. The malformation in the sella turcica/pituitary gland can be associated with a malformation within a developmental field that forms the craniofacial region (frontonasal, maxillary, palatal, and mandibular fields), sometimes also involving the brain stem, thymus, thyroid, and heart (velocardiofacial syndrome). Pathological sella turcica morphology can also be associated with malformations in the cerebellum and larynx (Cri-du-Chat syndrome). This review demonstrates the value of combining profile radiographic diagnostics with neuroradiological diagnostics in cases with malformed sella turcicae. PMID:23159420

  7. 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

  8. 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)

  9. 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...

  10. [The exposure dose of the sella turcica in panoramic dental radiography with an intraoral radiogenic source].

    PubMed

    Pastremoli, A; Cucchi, G; Ciminari, R

    1991-06-01

    Panoramic dental radiography using an intraoral X-ray source exposes critical organs, such as the crystalline and the thyroid, as well as organs of fundamental importance such as the pituitary gland, to X-rays. An experimental study was carried out to assess the exposure dose to the sella turcica during the radiological examination of the upper and lower dental arches using an X-ray source within the oral cavity. The comprehensive exposure dose for the upper and lower dental arches exceeded that found in orthopantomography (110 micro Gy/examination vs 47 micro Gy/examination) with errors which are respectively inferior to 15% and 30%. The authors conclude that the risk of provoking anatomical or functional changes of the pituitary gland is extremely remote using this type of examination.

  11. 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

  12. Solitary fibrous tumor of the sella mimicking pituitary adenoma: an uncommon tumor in a rare location-a case report.

    PubMed

    Furlanetto, Tania Weber; Pinheiro, Cláudio Faria Pitta; Oppitz, Paulo Petry; de Alencastro, Luiz Carlos; Asa, Sylvia L

    2009-01-01

    Solitary fibrous tumor (SFT) is rarely located in the central nervous system, and sella turcica involvement was reported in only two patients. We report the case of a 28-year-old man with a SFT of the sella turcica mimicking a pituitary nonfunctioning macroadenoma. He presented with optic nerve compression caused by a heterogeneous tumor located in the sellar and suprasellar area. At surgery, the tumor was hard and infiltrated the sellar diaphragm, so that resection resulted in a cerebrospinal fluid fistula. His postoperative course was also complicated by complete central diabetes insipidus, hypopituitarism, and two episodes of meningitis. After surgical resection, the diagnosis of SFT was reached on the basis of histological and immunohistochemical studies. He was discharged after 49 days. Ten months after surgery, he was clinically well, and magnetic resonance images showed no evidence of residual or recurrent tumor. SFT should be considered in the differential diagnosis of sellar and parasellar tumors.

  13. [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

  14. Bronchial carcinoid tumors metastatic to the sella turcica and review of the literature.

    PubMed

    Moshkin, Olga; Rotondo, Fabio; Scheithauer, Bernd W; Soares, Mark; Coire, Claire; Smyth, Harley S; Goth, Miklos; Horvath, Eva; Kovacs, Kalman

    2012-06-01

    We review here the literature on neuroendocrine neoplasms metastatic to the pituitary and present an example of the disease. Metastasis of bronchial carcinoid tumors to the sellar region are rare. Herein, we describe the case of a 63-year-old woman who presented with constant cough and headaches. She had previously been operated for carcinoid tumor of the lung. During the preoperative investigation, a CT scan of the head revealed a sellar mass. Six months after a left lower lobectomy, the sellar lesion was removed by transsphenoidal surgery. The two tumors were evaluated by histology, immunohistochemistry and electron microscopy. Both showed identical morphologic features, those of carcinoid tumor. Immunohistochemistry revealed immunoreactivity for the endocrine markers, synaptophysin and chromogranin, as well as CD-56, serotonin, bombesin and vascular endothelial growth factor. The sellar neoplasm showed nuclear immunopositivity for thyroid transcription factor-1, supporting the diagnosis of a metastatic bronchial carcinoid tumor. In conclusion, this is the first report of a serotonin- and bombesin-immunopositive atypical bronchial carcinoid tumor metastatic to the sella. PMID:22485018

  15. 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

  16. Effects of bromocriptine on CSF proteins and amines in patients with empty sella syndrome, acromegaly and prolactin producing pituitary adenomas.

    PubMed

    Brismar, K; Sidén, A; Werner, S

    1981-01-01

    The effect of the dopamine agonist bromocriptine (5-40 mg/day) on cerebrospinal fluid proteins and amines was studied in 7 hyperprolactinemic patients, 4 with empty sella syndrome and 3 patients with pituitary adenoma. Small as well as high doses of bromocriptine depressed the endogenously formed dopamine, noradrenalin and adrenalin. Five patients initially exhibited changes consistent with slight to marked blood-cerebrospinal-fluid (CSF) barrier disturbances and 5 abnormal CSF-protein fractions. One CSF-protein fraction (isolelectric points (pI) approximately 5.3 pH-units) became more prominent during bromocriptine treatment. Analyses of his fraction indicated that it represented a transferrin component. It is stated that bromocriptine treatment besides affecting amine and trace metal metabolism also affects protein metabolism.

  17. Morphology of arachnoid granulations and villi in the region of the human sella turcica--light microscopy and three-dimensional image analysis.

    PubMed

    Yamashita, K; Morita, F; Otsuki, Y; Magari, S

    1989-08-01

    The distribution and structure of the arachnoid granulations and villi in the region of the sella turcica in human adult brains were observed under light microscopy. In order to study the interrelationships between the arachnoid projections, hypophysis, cavernous sinus, and sella turcica, we performed a three-dimensional reconstruction and analysis of the region with the use of a digital image-processing method. Arachnoid projections penetrating the dura were villous when they were few in number, but more frequently granular when they were numerous. No relationship was observed between the type of projections and the age or the underlying disease of the subjects. Brains which showed no or few arachnoid granulations or villi had a small and deep hypophyseal fossa with a poorly-developed intercavernous sinus or venous plexus. Three-dimensional image analysis revealed that arachnoid granulations and villi form a maze in the dura or connective tissue between the venous plexuses.

  18. Anatomical features of skull base and oral cavity: a pilot study to determine the accessibility of the sella by transoral robotic-assisted surgery.

    PubMed

    Amelot, Aymeric; Trunet, Stephanie; Degos, Vincent; André, Olivier; Dionnet, Aurore; Cornu, Philippe; Hans, Stéphane; Chauvet, Dorian

    2015-10-01

    The role of transoral robotic surgery (TORS) in the skull base emerges and represents the natural progression toward miniinvasive resections in confined spaces. The accessibility of the sella via TORS has been recently described on fresh human cadavers. An anatomic study is mandatory to know if this approach would be feasible in the majority of patients regardless of their oral morphological features. From 30 skull base CT scans from patients who were asked to open their mouth as wide as they can, we measured specific dimensions of the oral cavity and the skull base, such as length of the palate, mouth opening and distance from the sella to the palate. All data were acquired on a sagittal midline plane and on a 25° rotation plane, which simulated the axis of the robotic instruments. Looking at the projection of the dental palatine line on the sella, we studied possible predictive factors of sellar accessibility and tried to bring objective data for surgical feasibility. We also proposed an angle α to study the working angle at the skull base. We observed that the maximal mouth opening was a good predictive factor of sellar accessibility by TORS (p < 0.05). The mouth aperture threshold value for a good sensitivity, over 80 %, was comparable to the mean value of mouth opening in our series, 38.9 and 39.4 mm respectively. Moreover, we showed a statistically significant increase of the working angle α at the skull base comparing the lateral access to the midline one (p < 0.05). This seemed to quantitatively demonstrate that the robotic arms placed at the labial commissure of the mouth can reach the sella. From these anatomical features and previous cadaveric dissections, we assume that TORS may be feasible on a majority of patients to remove pituitary adenomas.

  19. 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

  20. A Morphometric Study of the Foramen of Diaphragma Sellae and Delineation of Its Relation to Optic Neural Pathways through Computer Aided Superimposition

    PubMed Central

    Yohannan, Doris George; Krishnapillai, Renuka; Suresh, Romi; Ramnarayan, Shobha

    2015-01-01

    The diaphragma sellae (DS) is a fold of dura that forms a partial roof over the pituitary gland. The foramen of the diaphragma sellae (FDS) is thereby a pathway for suprasellar extension of pituitary tumors. The purpose of this study was to describe the anatomical dimensions of the DS and FDS and to understand the relationship of FDS with the overlying optic chiasma. The study was conducted in 100 autopsy cases. Measurements were taken using vernier calipers. Photographs, taken before and after removal of optic pathway, were superimposed using image processing software. The results showed that the mean A-P dimension of DS was 1.17 ± 0.48 cm; the lateral dimension of DS was 1.58 ± 0.60 cm. The mean A-P dimension of FDS was 0.66 ± 0.42 cm; the lateral dimension of FDS was 0.82 cm ± 0.54 cm. The shapes of FDS were irregular (40%), transversely oval (29%), circular (13%), sagittally oval (11%), or trapezoid with posterior dimension more than the anterior one (6%) or anterior dimension more than the posterior one (1%). The margins of FDS were either well defined (31%) or ill defined (69%). The positional relation of FDS to optic chiasma was also found out. PMID:26473083

  1. 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 ...

  2. 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

  3. 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

  4. A rare case of paraganglioma of the sella with bone metastases.

    PubMed

    Haresh, K P; Prabhakar, R; Anand Rajan, K D; Sharma, D N; Julka, P K; Rath, G K

    2009-01-01

    Sellar paragangliomas are very rare lesions with only 11 previous cases described in the literature. We present a further case of sellar paraganglioma. The patient is a 17-year-old man who developed headache, visual blurring, and diplopia. MRI showed a sellar lesion. Trans-nasal trans-sphenoid biopsy showed features of paraganglioma. He was treated by Stereotactic radiotherapy. Four months after treatment he developed bone metastases which was palliated by radiation, zoledronic acid, and chemotherapy. This is the first case of sellar paraganglioma showing metastases to bone. PMID:18320326

  5. [Observation of a male patient with the empty sella turcica syndrome].

    PubMed

    Bozadzhieva, E; Platonova, E; Sivchev, S; Dashev, G; Chavrakov, G

    1975-01-01

    One case with secondary developed syndrome of sell turcica is described, after hypophysis radiation on the occasion of acromegaly. Of special interest is the preserved tropic hypophysis secretion with a clinical picture of hypopituitarism (secondary developed hypogonadism, hypothyroidism and hypocorticism) as well as the combination with another brain neoplasm--astrocytoma.

  6. Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region

    PubMed Central

    2013-01-01

    Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region. PMID:23919255

  7. A case of reversible dilated cardiomyopathy due to acromegaly with partial empty sella.

    PubMed

    Doshi, Shrenik R; Punatar, Sachin B

    2012-01-01

    Acromegaly has several cardiovascular manifestations of which cardiomyopathy (CMP) and hypertension (HTN) are important and contribute to the increased mortality associated with the disease. Both these manifestations are reversible with treatment. However, very advanced CMP with severe systolic dysfunction has low likelihood of reversal. The reversibility is higher in young population and decreases as age advances. Also, the time required for these manifestations to resolve is about 1 year. Here, we describe a case in which HTN and advanced heart failure resolved in an aged patient within a very short span of 2 months from the time of presentation.

  8. 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

  9. The diagnostic value of hyperostosis in midline subfrontal meningioma.

    PubMed

    Lee, K F

    1976-04-01

    Roentgenologic analysis of 66 patients with proved midline subfrontal meningioma indicates a very high incidence of hyperostosis. A total of 63 patients (95%) showed varying degrees of hyperostosis involving the cribiform plate, planum sphenoidale, or tuberculum sellae (including the chiasmatic sulcus). The planum sphenoidale is the most common site of hyperostosis (59%). In 19 cases (29%), the region of hyperostosis did not correspond to the site of tumor attachment. Mild or localized hyperostosis may be apparent only on tomograms. Small "blistering" and "saw-tooth-like" osteoma formation are reliable early signs of midline subfrontal meningioma; conversely, midline subfrontal meningioma can be virtually ruled out if hyperostosis is absent.

  10. Cushing's disease: management by transsphenoidal pituitary microsurgery.

    PubMed

    Bigos, S T; Somma, M; Rasio, E; Eastman, R C; Lanthier, A; Johnston, H H; Hardy, J

    1980-02-01

    Over 15 yr, 24 patients underwent transsphenoidal pituitary surgery for Cushing's disease with a median follow-up of 12 months. Cures included 7 patients with normal sella turcicas (6 microadenomas), 6 patients with focal depressions (6 microadenomas) of the sella (grade I), and 3 patients (3 adenomas) with enlarged sellas (grade II). Three patients with sella destruction (grades III and IV), 2 with normal sellas, and 1 with focal sella depression (grade I) were not cured. Two apparent cures (microadenomas) recurred. Tumor histology revealed 19 basophilic adenomas; electron microscopy (14 tumors) and immunochemical studies (10 tumors) revealed only ACTH cells. Circadian rhythm returned in 6 cured patients. Impotence (in 2), amenorrhea (in 7), and galactorrhea (in 3) resolved in affected cured patients. The major surgical complication was hemorrhage at the operative site (3 patients). Transsphenoidal pituitary surgery is a valuable method for managing Cushing's disease in many patients.

  11. 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 ...

  12. 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 ...

  13. 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 ...

  14. 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 . ...

  15. Skull Base Meningiomas and Cranial Nerves Contrast Using Sodium Fluorescein: A New Application of an Old Tool

    PubMed Central

    da Silva, Carlos Eduardo; da Silva, Vinicius Duval; da Silva, Jefferson Luis Braga

    2014-01-01

    Objective The identification of cranial nerves is one of the most challenging goals in the dissection of skull base meningiomas. The authors present an application of sodium fluorescein (SF) in skull base meningiomas with the purpose of improving the identification of cranial nerves. Design A prospective study within-subjects design. Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil. Participants Patients with skull base meningiomas. Main Outcomes Measures Cranial nerve identification. Results The group of nine meningiomas was composed of one cavernous sinus, three petroclival, one tuberculum sellae, two sphenoid wing, one olfactory groove, and one temporal floor meningioma. The SF enhancement in all tumors was strong, and the contrast with cranial nerves clearly evident. There were one definite olfactory nerve deficit, one transient abducens deficit, and one definite hemiparesis. All lesions were resected (Simpson grades 1 and 2). The analysis of the difference of the delta SF wavelength between the meningiomas and cranial nerve contrast was performed by the Wilcoxon signed rank test and showed p = 0.011. Conclusions The contrast between the enhanced meningiomas and cranial nerves was evident and assisted in the visualization and microsurgical dissection of these structures. The anatomical preservation of these structures was improved using the contrast. PMID:27054056

  16. Feasibility of Piezoelectric Endoscopic Transsphenoidal Craniotomy: A Cadaveric Study

    PubMed Central

    Tomazic, Peter Valentin; Gellner, Verena; Koele, Wolfgang; Hammer, Georg Philipp; Braun, Eva Maria; Gerstenberger, Claus; Clarici, Georg; Holl, Etienne; Braun, Hannes; Stammberger, Heinz; Mokry, Michael

    2014-01-01

    Objective. Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps—as in external craniotomies—is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies. Study Design. Cadaveric study. Methods. On cadaveric specimens (N = 5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3–5 cm2. Results. Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures. Conclusion. In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap. PMID:24689037

  17. Skull Base Meningiomas and Cranial Nerves Contrast Using Sodium Fluorescein: A New Application of an Old Tool.

    PubMed

    da Silva, Carlos Eduardo; da Silva, Vinicius Duval; da Silva, Jefferson Luis Braga

    2014-08-01

    Objective The identification of cranial nerves is one of the most challenging goals in the dissection of skull base meningiomas. The authors present an application of sodium fluorescein (SF) in skull base meningiomas with the purpose of improving the identification of cranial nerves. Design A prospective study within-subjects design. Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil. Participants Patients with skull base meningiomas. Main Outcomes Measures Cranial nerve identification. Results The group of nine meningiomas was composed of one cavernous sinus, three petroclival, one tuberculum sellae, two sphenoid wing, one olfactory groove, and one temporal floor meningioma. The SF enhancement in all tumors was strong, and the contrast with cranial nerves clearly evident. There were one definite olfactory nerve deficit, one transient abducens deficit, and one definite hemiparesis. All lesions were resected (Simpson grades 1 and 2). The analysis of the difference of the delta SF wavelength between the meningiomas and cranial nerve contrast was performed by the Wilcoxon signed rank test and showed p = 0.011. Conclusions The contrast between the enhanced meningiomas and cranial nerves was evident and assisted in the visualization and microsurgical dissection of these structures. The anatomical preservation of these structures was improved using the contrast.

  18. 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

  19. 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.

  20. Dural invasion by pituitary tumours.

    PubMed

    Shaffi, O M; Wrightson, P

    1975-04-23

    In 12 cases of pituitary tumour the dura mater of the sella turcica or diaphragma sellae in contact with the tumour was examined histologically. In nine cases tumour cells were found lying deep in the substance of the dura. Dura from the sella of seven subjects without pituitary disease, obtianed at autopsy, showed no inclusions of pituitary tissue. Four of the cases studied were known before death to suffer from an invasive pituitary adenoma. Of eight surviving cases operated upon in the last two years, five showed dural invasion by tumour. The present report suggests that the condition may be more frequent than expected and that with more study it may provide an index of prognosis. It also defines a requirement for the surgeon aiming to prevent recurrence of tumour after operation or to achieve a complete endocrine ablation.

  1. Endoscopic transsphenoidal treatment of a prolactinoma patient with brain and optic chiasmal herniations.

    PubMed

    Zhang, Ning; Guo, Liemei; Ge, Jianwei; Qiu, Yongming

    2014-05-01

    Bromocriptine has been the most widely used and effective agent to treat macroprolactinoma, and chiasmal herniation in a macroprolactinoma patient following the treatment with bromocriptine is a well-recognized complication. However, herniation of the inferior mesial frontal lobe into the sella has been rarely reported. The present clinical report is the second radiographic demonstration of herniation of the inferior mesial frontal lobe into the sella. After the treatment with transsphenoidal endoscopic chiasmopexy, the patient's visual disturbance improved dramatically. We suggest that transsphenoidal endoscopic chiasmopexy is an effective treatment option for the prolactinoma patient with brain and chiasmal herniations following the treatment with bromocriptine.

  2. Fat deposition in the cavernous sinus in Cushing disease

    SciTech Connect

    Bachow, T.B.; Hesselink, J.R.; Aaron, J.O.; Davis, K.R.; Taveras, J.M.

    1984-10-01

    Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 (37.5%) patients with Cushing disease. This finding may aid in making a specific diagnosis in patients with a pituitary mass. It was not seen in 30 random CT studies of the sella; however, supra seller fat was incidentally noted in the patient with acromegaly.

  3. Malignant glioma of the optic chiasm eight years after radiotherapy for prolactinoma

    SciTech Connect

    Hufnagel, T.J.; Kim, J.H.; Lesser, R.; Miller, J.M.; Abrahams, J.J.; Piepmeier, J.; Manuelidis, E.E.

    1988-12-01

    A 41-year-old man had rapidly progressive visual loss caused by a malignant glioma that developed in the optic chiasm eight years after radiation therapy for a recurrent prolactinoma. Radiation-induced glioma should be considered as a cause of progressive visual loss in patients who have received irradiation in the region of the sella turcica.

  4. Silent corticotroph adenoma with adrenal cortical choristoma: a rare but distinct morphological entity.

    PubMed

    Mete, Ozgur; Ng, Thomas; Christie-David, Darshika; McMaster, Jacqueline; Asa, Sylvia L

    2013-09-01

    This report describes a case of pituitary adenoma with interspersed adrenal cortical cells. The pituitary cells were confirmed to be corticotrophs with Tpit and adrenocorticotropic hormone immunohistochemistry, whereas the adrenal cortical cells were verified to be such with steroidogenic factor-1 (SF-1), inhibin, calretinin, and Melan A staining. The presence of normal adrenal cortical cells in the heterotopic location of the sella fulfills the definition of choristoma. The origin of adrenal cortical cells within a pituitary adenoma remains unexplained. The important role of SF-1 in both pituitary and adrenal cortex may explain a relationship that supports the possibility of an abnormal proliferation and differentiation of uncommitted mesenchymal stem cells within the sella. However, it remains possible that misplaced adrenal cortical cells derived during embryogenesis give rise to this rare but distinct morphological entity that can pose a difficult diagnostic dilemma. The approach to differential diagnosis is discussed.

  5. High Le Fort I osteotomy for correction of mid-face deformity in Crouzon syndrome.

    PubMed

    Nakajima, Yasumichi; Nakano, Hiroyuki; Sumida, Tomoki; Yamada, Tomohiro; Inoue, Kazuya; Sugiyama, Goro; Mishima, Katsuaki; Mori, Yoshihide

    2016-09-01

    An 18-year-old woman with mild Crouzon syndrome was referred with malocclusion and mandibular protrusion. Examination revealed Class III canine and molar relationships, hypoplastic maxilla, 1-mm overbite, and -2-mm overjet. Analysis showed 69° sella-nasion-A, 73.6° sella-nasion-B, and -4.6° A point-nasion-B point angles. Polysomnography revealed respiratory disturbance and 6.3% oxygen desaturation indices of 5.4/h and 9.0/h. We performed double-jaw surgery using high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy for midfacial deformity correction. Twelve months post-surgery, her measures were 70.8°, 72°, -1.2°, 3.0/h, and 6.1/h, respectively. Esthetics were satisfactory. High Le Fort I osteotomy is effective for midfacial deformity correction in patients with Crouzon syndrome.

  6. High Le Fort I osteotomy for correction of mid-face deformity in Crouzon syndrome.

    PubMed

    Nakajima, Yasumichi; Nakano, Hiroyuki; Sumida, Tomoki; Yamada, Tomohiro; Inoue, Kazuya; Sugiyama, Goro; Mishima, Katsuaki; Mori, Yoshihide

    2016-09-01

    An 18-year-old woman with mild Crouzon syndrome was referred with malocclusion and mandibular protrusion. Examination revealed Class III canine and molar relationships, hypoplastic maxilla, 1-mm overbite, and -2-mm overjet. Analysis showed 69° sella-nasion-A, 73.6° sella-nasion-B, and -4.6° A point-nasion-B point angles. Polysomnography revealed respiratory disturbance and 6.3% oxygen desaturation indices of 5.4/h and 9.0/h. We performed double-jaw surgery using high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy for midfacial deformity correction. Twelve months post-surgery, her measures were 70.8°, 72°, -1.2°, 3.0/h, and 6.1/h, respectively. Esthetics were satisfactory. High Le Fort I osteotomy is effective for midfacial deformity correction in patients with Crouzon syndrome. PMID:27092811

  7. [My hands hurt so much!].

    PubMed

    Rüst, Christoph A; Rosemann, Thomas; Knechtle, Beat

    2014-11-26

    We present the case of a 48-year-old man complaining of pain in his hands. In a first step, a two-sided carpal tunnel syndrome was found, and in the further course of the disease an acromegaly. The combinations of carpal tunnel syndrome, impaired glucose tolerance and radiological findings in the area of the sella turcica were the clues for the diagnosis of acromegaly.

  8. Holographic and cephalometric study of the relationship between craniofacial morphology and the initial reactions to high-pull headgear traction.

    PubMed

    Duterloo, H S; Kragt, G; Algra, A M

    1985-10-01

    Eight macerated human child skulls with a dental age of approximately 9.5 years (mixed dentition) were consecutively subjected to an experimental standardized high-pull headgear traction system attached to the maxilla at the first permanent molar area via an immovable acrylic resin splint covering all teeth. This system produced tensile forces from 0.5 to 3.5 N (1 N = 0.10 kg) per side. Laser holography was used to measure displacements in a three-dimensional coordinate system. Displacements varied in direction. In addition, conventional cephalometric analysis of standardized lateral roentgen cephalograms was performed. Displacements and cephalometric data were then compared. Results indicate that the direction of initial displacements of bones of the facial skeleton bears a definite relationship to the morphology of the individual skull. In skulls with high divergency values (large angles, sella-nasion-occlusal plane, sella-nasion-mandibular plane), displacements are in a backward and posterior downward direction; in skulls with a small sella-nasion-occlusal plane angle, backward displacements occur in a direction almost parallel to the occlusal plane.

  9. Pituitary apoplexy due to prolactinoma in a Taiwanese boy: patient report and review of the literature.

    PubMed

    Yang, Min-Hui; Chuang, Huoli; Jung, Shih-Ming; Van, Yang-Hau; Lo, Fu-Sung

    2003-12-01

    We report a Taiwanese boy who presented with apoplexy of a prolactinoma. A 12 9/12 year-old boy presented to our clinic with headache and visual deficit of bitemporal hemianopsia. Skull X-ray showed an enlarged sella. Magnetic resonance imaging (MRI) of the sella turcica showed a 4 x 2.5 x 2.5 cm mass, located at the sella turcica and extending upward to compress the optic chiasm. Preoperative laboratory data showed hyperprolactinemia, hypothyroidism and hypocortisonism. After a stress dose of i.v. hydrocortisone was given, he underwent transsphenoid surgery to remove the tumor. Immunohistochemical stains were positive for PRL in the tumor cells. After surgery, he suffered from neurogenic diabetes insipidus, hypopituitarism and hyperprolactinemia, with serum PRL level of 491 ng/ml. Visual field examination was normal 4 months later. In conclusion, pituitary apoplexy is rare in children but should be considered if a patient suffers from headache, vomiting, and visual deficit. Brain MRI is preferred for diagnosis. Dopaminergic agonists should be given if residual tumor or recurrence of prolactinoma is found after transsphenoidal surgery.

  10. 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

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

    NASA Astrophysics Data System (ADS)

    Keim, Lorenz; Brandner, Rainer

    2001-11-01

    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

  12. 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

  13. 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.

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

    PubMed

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

    2016-07-01

    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

  15. [Case report: bilateral Cushing's syndrome].

    PubMed

    Cheikhrouhou, Héla; Khiari, Karima; Chérif, Lotfi; Ben Abdallah, Néjib; Ben Maïz, Hédi

    2003-04-01

    The authors report a case of a 49-year-old woman presenting a Cushing's syndrome (January 1997). The Magnetic Resonance Image of the pituitary gland revealed a microadenoma without extension in the cavernous sinus and a partial empty sella. The computed tomography scan showed a discreet bilateral adrenal hyperplasia with a left nodule (23 mm in diameter) a second nodule was noted. These data suggested the eventuality of maconodular adrenocortical hyperplasia in long-standing Cushing's disease. We discuss the implications of this finding for diagnosis, treatment and follow-up.

  16. 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

  17. Familial acromegaly with pituitary adenoma. Report of three affected siblings.

    PubMed

    Abbassioun, K; Fatourehchi, V; Amirjamshidi, A; Meibodi, N A

    1986-03-01

    The authors report the cases of three brothers with pituitary adenomas who had classical findings of acromegaly and gigantism. Two had irreducibly elevated growth hormone (GH) values and underwent transsphenoidal microsurgical extirpation of their tumors. The third acromegalic brother had a normal GH value and evidence of panhypopituitarism; he had a small intrasellar tumor and a partially empty sella. The pattern of inheritance was probably autosomal recessive. A review of literature indicated that familial incidence of isolated acromegaly with pituitary adenomas is rare. PMID:3950729

  18. Complications of nephropathia epidemica: three cases.

    PubMed

    Forslund, T; Saltevo, J; Anttinen, J; Auvinen, S; Brummer-Korvenkontio, M; Korhonen, A; Poutiainen, M

    1992-07-01

    Haemorrhagic fever with renal syndrome (HFRS) in Scandinavia is called nephropathia epidemica (NE), and is caused by the Puumala-virus, which belongs to the Hanta-virus genus. The clinical course of NE is mostly benign, complications are uncommon, and deaths are rarely observed. We report the cases of three patients who developed serious complications in the course of NE caused by the Puumala-virus. One patient died within 24 h after admission, another developed progressive neuromuscular dysfunction (Guillain-Barré syndrome) which required auxiliary ventilation for several weeks before a slow recovery, and a third patient developed empty sella syndrome with pituitary gland insufficiency. In the first two cases the diagnosis of NE was confirmed by a rapid avidity assay for IgG antibody against Puumala-virus. In the third case the clinical course, and demonstration of NE immunity 16 years later, suggested that NE might have caused the hypopituitarism. Some patients with NE caused by the Puumala-virus may require intensive-care treatment, and the development of late complications such as empty sella syndrome and hypopituitarism should be taken into consideration.

  19. 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

  20. Quantitative analysis of anatomical relationship between cavernous segment internal carotid artery and pituitary macroadenoma

    PubMed Central

    Lin, Bon-Jour; Chung, Tzu-Tsao; Lin, Meng-Chi; Lin, Chin; Hueng, Dueng-Yuan; Chen, Yuan-Hao; Hsia, Chung-Ching; Ju, Da-Tong; Ma, Hsin-I; Liu, Ming-Ying; Tang, Chi-Tun

    2016-01-01

    Abstract Cavernous segment internal carotid artery (CSICA) injury during endoscopic transsphenoidal surgery for pituitary tumor is rare but fatal. The aim of this study is to investigate anatomical relationship between pituitary macroadenoma and corresponding CSICA using quantitative means with a sense to improve safety of surgery. In this retrospective study, a total of 98 patients with nonfunctioning pituitary macroadenomas undergoing endoscopic transsphenoidal surgeries were enrolled from 2005 to 2014. Intercarotid distances between bilateral CSICAs were measured in the 4 coronal levels, namely optic strut, convexity of carotid prominence, median sella turcica, and dorsum sellae. Parasellar extension was graded and recorded by Knosp–Steiner classification. Our findings indicated a linear relationship between size of pituitary macroadenoma and intercarotid distance over CSICA. The correlation was absent in pituitary macroadenoma with Knosp–Steiner grade 4 parasellar extension. Bigger pituitary macroadenoma makes more lateral deviation of CSICA. While facing larger tumor, sufficient bony graft is indicated for increasing surgical field, working area and operative safety. PMID:27741111

  1. The potential role of stereolithography in the study of facial aging.

    PubMed

    Pessa, J E

    2001-02-01

    The potential role of high-resolution stereolithography for the study of facial aging was evaluated. Stereolithography has been used extensively in the engineering sciences to create model replicas prior to full production. More recently, stereolithography has found a role in the preoperative planning of complex dentofacial anomalies. Previous work has suggested that continued differential growth of the maxilla may occur throughout life. To further evaluate this finding, computed tomography scans were collected from younger (mean, 20.2 years) and older (mean, 58.8 years) individuals (N = 20). Both men and women were included. An exact replica of the facial skeleton was made for each subject by the process of laser polymerization. The angles of the maxillary wall and piriform aperture, defined by specific points, were measured relative to sella-nasion. Height, width, and depth changes were also evaluated. Findings show that angular changes occurred with age. The mean angle of the maxilla relative to sella-nasion decreased from 69 degrees to 56.8 degrees with age (P =.015). The mean angle of the piriform likewise decreased from 65.1 degrees to 55.7 degrees (P =.019). This angular change with age suggests that differential growth may continue throughout life. This work highlights the potential role of 3-dimensional modeling for future research in the field of facial aging. Curve and contour analysis are 2 additional areas in which stereolithography may yield valuable insights into the mechanisms of facial growth.

  2. [Etiological diagnosis of central diabetes insipidus: about 41 cases].

    PubMed

    Chaker, Fatma; Chihaoui, Melika; Yazidi, Meriem; Slimane, Hedia

    2016-01-01

    The occurrence of polyuria-polydipsia syndrome with hypotonic urine requires careful diagnostic strategy. This study aims to evaluate diagnostic modalities for central diabetes insipidus. We conducted a retrospective study of 41 cases with central diabetes insipidus (CDI). Data were collected at the Department of Endocrinology, University Hospital La Rabta, Tunis, from 1990 to 2013. We identified the circumstances for detecting CDI, the abnormalities in anterior pituitary assessment and pituitary imaging. CDI occurred in the postoperative period in 20 patients. The average urine 24-hour volume was significantly higher in patients with CDI outside a surgical setting. Water deprivation test was successful in all patients who benefited from it. Outside of neurosurgery, infiltration causes were found in 6 patients and tumor causes were found in 6 patients. CDI was associated with empty sella turcica in 1 case and idiopathic sella turcica in 3 patients. Hypothalamic-pituitary magnetic resonance imaging and anterior pituitary balance sheet are systematic outside pituitary surgery setting and obvious primary polydipsia.

  3. 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

  4. Neuroendocrine disorders: pituitary imaging.

    PubMed

    Faje, Alexander; Tritos, Nicholas A; Swearingen, Brooke; Klibanski, Anne

    2016-01-01

    Significant advances in pituitary imaging have taken place in the past several decades, including the introduction of magnetic resonance imaging (MRI). This imaging modality has vastly improved our ability to detect and characterize sellar masses and more accurately characterize the extent and spread of lesions in and around the sella. Intraoperative MRI may help improve the completeness of resection of sellar masses. Other imaging modalities, including magnetic resonance angiography, computed tomography (CT), and CT angiography, have an important role in specific cases. Interventional methods, including bilateral inferior petrosal sinus sampling, may establish the pituitary origin of corticotropin (ACTH) excess in patients with ACTH-dependent Cushing's syndrome. Pituitary imaging should be obtained in patients with pituitary hormone excess, hypopituitarism, or mass effect in the sella. Despite rapid advances in pituitary imaging, there are several diagnostic challenges remaining. Future research may help improve the radiographic detection of small sellar lesions, such as ACTH-secreting adenomas causing Cushing's disease, accurately characterize the type and extent of sellar pathologies, and provide prognostic information regarding their growth potential. PMID:27430447

  5. [Etiological diagnosis of central diabetes insipidus: about 41 cases].

    PubMed

    Chaker, Fatma; Chihaoui, Melika; Yazidi, Meriem; Slimane, Hedia

    2016-01-01

    The occurrence of polyuria-polydipsia syndrome with hypotonic urine requires careful diagnostic strategy. This study aims to evaluate diagnostic modalities for central diabetes insipidus. We conducted a retrospective study of 41 cases with central diabetes insipidus (CDI). Data were collected at the Department of Endocrinology, University Hospital La Rabta, Tunis, from 1990 to 2013. We identified the circumstances for detecting CDI, the abnormalities in anterior pituitary assessment and pituitary imaging. CDI occurred in the postoperative period in 20 patients. The average urine 24-hour volume was significantly higher in patients with CDI outside a surgical setting. Water deprivation test was successful in all patients who benefited from it. Outside of neurosurgery, infiltration causes were found in 6 patients and tumor causes were found in 6 patients. CDI was associated with empty sella turcica in 1 case and idiopathic sella turcica in 3 patients. Hypothalamic-pituitary magnetic resonance imaging and anterior pituitary balance sheet are systematic outside pituitary surgery setting and obvious primary polydipsia. PMID:27642481

  6. 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.

  7. Extracranial Infrasellar Ectopic Craniopharyngioma: A Case Report and Review of the Literature

    PubMed Central

    Nourbakhsh, Ali; Brown, Benjamin; Vannemreddy, Prasad; Lian, Timothy; Nanda, Anil; Guthikonda, Bharat

    2010-01-01

    We present a case of a purely infrasellar craniopharyngioma that initially presented as a sphenoid sinus mass. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature. A 25-year-old woman presented with 6-month history of progressive headaches. Initial neuroimaging revealed the presence of a sphenoid sinus mass. Initially, she underwent an endoscopic biopsy of the mass by our ENT service. Pathology was consistent with craniopharyngioma and she was referred to neurosurgery for further surgical management. She then underwent an endoscopic transsphenoidal approach for complete resection of the purely extracranial, infrasellar craniopharyngioma. The Rathke pouch arises from the roof of the primitive mouth and grows toward the brain at the fourth week of gestation. Normally, it loses its attachment with the stomadeum completely by the eighth week of gestation. The craniopharyngeal canal (CPC) extends from the floor of the sella to the vomer and may rarely give rise to ectopic craniopharyngiomas. This case shows that such ectopic tumors may arise anywhere along the CPC. Endoscopic endonasal approach provides an excellent route for the resection of these tumors. PMID:21772808

  8. Pituitary function and morphology in Fabry disease.

    PubMed

    Maione, Luigi; Tortora, Fabio; Modica, Roberta; Ramundo, Valeria; Riccio, Eleonora; Daniele, Aurora; Belfiore, Maria Paola; Colao, Annamaria; Pisani, Antonio; Faggiano, Antongiulio

    2015-11-01

    Endocrine abnormalities are known to affect patients with Fabry disease (FD). Pituitary gland theoretically represents an ideal target for FD because of high vascularization and low proliferation rate. We explored pituitary morphology and function in a cohort of FD patients through a prospectic, monocentric study at an Academic Tertiary Center. The study population included 28 FD patients and 42 sex and age-matched normal subjects. The protocol included a contrast enhancement pituitary MRI, the assessment of pituitary hormones, anti-pituitary, and anti-hypothalamus antibodies. At pituitary MRI, an empty sella was found in 11 (39%) FD patients, and in 2 (5%) controls (p < 0.001). Pituitary volume was significantly smaller in FD than in controls (p < 0.001). Determinants of pituitary volume were age and alpha-galactosidase enzyme activity. Both parameters resulted independently correlated at multivariate analysis. Pituitary function was substantially preserved in FD patients. Empty sella is a common finding in patients with FD. The major prevalence in the elderly supports the hypothesis of a progressive pituitary shrinkage overtime. Pituitary function seems not to be impaired in FD. An endocrine workup with pituitary hormone assessment should be periodically performed in FD patients, who are already at risk of cardiovascular complications.

  9. 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

  10. Angioleiomyoma, a rare intracranial tumor: 3 case report and a literature review

    PubMed Central

    2014-01-01

    Three cases of intracranial angioleiomyoma (ALM) in our neurosurgery center are reported in detail. ALM is a benign soft tissue tumor comprised of mature smooth muscle cells and a prominent vascular component, which is extremely rare as a primary intracranial lesion. Altogether, only 12 cases were recorded in the literature to date, to the best of our knowledge. Case 1 is the second report of intra-sella ALM, a 51-year-old woman presented with visual deterioration for 2 months. An MRI showed an intra-sella 3-cm tumor, partially flame-like, enhanced with gadolinium. Using microscopic endonasal transsphenoidal approach, the tumor was completely resected with great difficulty. At 11 days post-surgery, she died of a sudden catastrophic nasal hemorrhage. An angiography revealed a pseudo-aneurysm of ICA (internal carotid artery). Case 2 is a 49-year-old man who presented with weakness of the lower limbs for 1 year. A large subtentorial mass was found affixed to the torcular and straight sinus, which was partially flame-like, dramatically enhanced as in case 1. Case 3 is that of a 77-year-old man. An ALM mass was revealed in the diploe of left temporal bone, and had eroded the inner table. Immunohistochemical workup confirmed the diagnosis of angioleiomyoma in all 3 cases. The radiology, operation, and complication of surgery in each case were discussed. In conclusion, intracranial ALMs are extremely rare, usually located ex-neuro axis (such as in our cases), in the sella, in posterior fossa, or in the skull. Magnetic resonance imaging (MRI) revealed a special feature of flame-like partial enhancement that may be helpful to distinguish ALM from pituitary tumors or meningiomas, and should result in the consideration of this rare tumor entity early on in the diagnostic process. A definitive diagnosis depends on histological analyses. The resection of ALM in certain locations is difficult and risky because of the rich blood supply. PMID:25027207

  11. 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

  12. Bilateral Osseous Interclinoid Bridges Associated with Foramina of Vesalius: A Case Report.

    PubMed

    Paraskevas, George; Nitsa, Zoi; Koutsouflianiotis, Konstantinos

    2015-07-01

    The current study displays a very rare combination of ossified interclinoid ligaments at the sella turcica region associated with bilateral foramina of Vesalius. In a macerated skull four osseous bars interconnecting the clinoid processes bilaterally were detected. Specifically, two bilateral osseous bars were observed bridging the gap between the anterior and middle clinoid processes forming the so called caroticoclinoid foramen on each side and two additional osseous bridges linked the anterior and posterior clinoid processes, bilaterally. Furthermore, two distinct bilateral foramina of Vesalius were documented just anterior and medial to the foramen ovale. The awareness of the osseous sellar bridges is crucial for the physician and especially the neurosurgeon since their presence may complicate the removal of clinoid processes and induce damage of the internal carotid artery and oculomotor nerves. Furthermore, the likely existence of the foramen of Vesalius may lead to transfer of an infected thrombus into the cranial cavity and complicate a percutaneous trigeminal rhizotomy.

  13. 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.

  14. 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.

  15. 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.

  16. Total resection of a solitary fibrous tumor of the sellar diaphragm: A case report.

    PubMed

    Zhong, Qisheng; Yuan, Shaoji

    2013-06-01

    The present study reports the case of a patient with a vision impairment in the right eye. Head computed tomography revealed a round, hyperdense mass in the sellar and suprasellar regions. Pituitary gland magnetic resonance imaging (MRI) revealed isointensity on T1- and T2-weighted imaging. Tumor-enhanced scanning showed heterogeneous contrast enhancement. The initial diagnosis was that of meningioma or pituitary tumor. A total tumor resection was performed using a right pterional approach under general anesthesia. During surgery, the base of the tumor was located on the sellar diaphragm of the left anterior pituitary stalk. The pathological diagnosis was of a solitary fibrous tumor (SFT). The patient had no post-operative diabetes insipidus or idiopathic pituitary hypofunction. The clinical experience, imaging information and pathological features of SFT in this case report may provide a reference for correct diagnosis and total resection of SFTs in the sella turcica.

  17. Endoscopic repair of spontaneous cerebro-spinal fluid rhinorrhoea: a report of 3 cases.

    PubMed

    Gendeh, B S; Wormald, P J; Forer, M; Goh, B S; Misiran, K

    2002-12-01

    Three cases of spontaneous Cerebrospinal Fluid (CSF) rhinorrhea were managed at the National University Hospital, Kuala Lumpur. Case 1 had bilateral leak secondary to empty sella syndrome and the rest two cases had unilateral leak. Four transnasal endoscopic approaches were performed on these three cases since March 1999. The role of intrathecal Sodium Fluorescein is highlighted in localising the CSF fistula. Case 3 required postoperative lumbar drain as an adjunct. No recurrent leak was noted on post operative follow up in Case 2 and 3 ranging from nine to thirty two months. A recurrent left leak at six months was noted in Case 1 which could likely be due to her sudden bout of cough attacks and patient refused further surgical intervention. PMID:12733180

  18. Craniofacial abnormalities in Hutchinson-Gilford progeria syndrome.

    PubMed

    Ullrich, N J; Silvera, V M; Campbell, S E; Gordon, L B

    2012-09-01

    HGPS is a rare syndrome of segmental premature aging. Our goal was to expand the scope of structural bone and soft-tissue craniofacial abnormalities in HGPS through CT or MR imaging. Using The Progeria Research Foundation Medical and Research Database, 98 imaging studies on 25 patients, birth to 14.1 years of age, were comprehensively reviewed. Eight newly identified abnormalities involving the calvaria, skull base, and soft tissues of the face and orbits were present with prevalences between 43% and 100%. These included J-shaped sellas, a mottled appearance and increased vascular markings of the calvaria, abnormally configured mandibular condyles, hypoplastic articular eminences, small zygomatic arches, prominent parotid glands, and optic nerve kinking. This expanded craniofacial characterization helps link disease features and improves our ability to evaluate how underlying genetic and cellular abnormalities culminate in a disease phenotype.

  19. 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.

  20. [The best approach to treat prolactinoma].

    PubMed

    Zárate, Arturo; Saucedo, Renata; Basurto, Lourdes

    2004-01-01

    The prolactinoma is the most frequent pituitary tumor; the clinical presentation in women is characterized by menstrual disorders, amenorrhea, galactorrhea and/or sterility; neurological symptoms are present only when the tumor exceeds the sella turcica which is exceptional. Prolactin levels over 100 ng/mL are usually diagnostic of prolactinoma, as long as there are no pregnancy and/or hypothyroidism. The first therapeutical option is dopamine agonist drugs, thus surgery has been practically eliminated. Dopaminergic drugs suppress both synthesis and prolactin secretion, which in turn restores the ovarian function and induces tumor shrinkage. In conclusion, dopamine agonists constitute the prolactinoma treatment; in addition drug withdrawal is followed by remission of prolactinoma activity. In men, the size of the prolactinoma is larger, macroprolactinoma which usually presents extrasellar extension accompanied of neurological and visual symptoms; however the prolactinoma exhibits a favorable response with dopaminergic drugs.

  1. 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

  2. Vascularized Nasoseptal Flap for Medial Orbital Wall Reconstruction.

    PubMed

    Turel, Mazda K; Chin, Christopher J; Vescan, Allan D; Gentili, Fred

    2016-09-01

    With the use and efficacy of the vascularized nasoseptal flap, its indications are also expanding. Due to its relative ease of harvesting and no significant impairment in the long-term sinonasal quality of life, the flap has been used for a number of other purposes apart from its originally proposed use in reconstruction of the anterior cranial fossa, sella, and the clivus. Its use may negate the need of another incision to obtain fat or fascia. The authors describe the case of a 47-year-old lady who underwent endoscopic excision of a medially placed orbital intraconal hemangioma who presented to us with very poor vision in the left eye. The large medial orbital defect was reconstructed with a vascularized pedicled nasoseptal flap from the ipsilateral side. The patient made an excellent visual and sino-nasal recovery. This patient highlights a unique use for the proliferating indications for the use of the nasoseptal flap. PMID:27428902

  3. 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

  4. Large pituitary incidentaloma in a patient with sarcoidosis

    PubMed Central

    Jalota, Leena; Abaroa-Salvatierra, Ana; Alweis, Richard

    2014-01-01

    A 60 year old male with a medical history of pulmonary sarcoidosis and chronic low testosterone presented to his allergist for excessive lacrimation. Computed tomography (CT) scan of sinuses ordered for possible blocked nasolacrimal duct revealed an abnormal expansion of the sella turcica. Magnetic resonance imaging suggested a homogeneously enhancing 4 cm soft tissue mass enveloping the internal carotid and abutting the optic nerves. Since the patient indicated no symptoms, it was felt to be consistent with a pituitary incidentaloma. Laboratory investigation showed only minimally elevated prolactin. Visual field testing at the office was normal but computed campimetry was suggestive of few minimally depressed points in the supra-temporal quadrant on the right. Even with high suspicion of neurosarcoidosis, the patient had a surgical indication so he underwent transsphenoidal excision of the mass with no complications. Pathology was consistent with a null-cell pituitary adenoma. PMID:25147632

  5. 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

  6. Hypopituitarism following poisonous viperbite.

    PubMed

    Bandyopadhyay, Sanjay Kumar; Bandyopadhyay, Ranjana; Dutta, Anita; Pal, Salil Kumar

    2012-02-01

    A 28 years old male had the history of viperbite 3 years back. He has treated in a nearby rural hospital with snake venom antiserum along with other supportive therapy. He responded and discharged from hospital within a week. Three years later he had history of fever, drowsiness which progressed to unconsciousness. On examination he was found to have scanty body hairs, smooth, shiny skin with superficial oral ulcers. Serum hormone estimation confirmed the deficiency of gonadotrophins, thyrotrophin and corticotrophin while growth hormone failed to rise >3ng/ml after insulin intolerance test. MRI brain revealed loss of pituitary mass with positive infundibular sign and filling of sella with cerebrospinal fluid. He was managed with hormone replacement therapy and recovered gradually.

  7. Pituitary Chondrosarcoma presenting as a sellar and suprasellar mass with parasellar extension: An Unusual presentation

    PubMed Central

    Sharma, Manisha; Madan, Manas; Manjari, Mridu; Kaur, Harleen

    2016-01-01

    Chondrosarcoma is a mesenchymal tumor composed of tumor cells producing cartilage. It is more common in older age and often affects the axial skeleton. We report a rare case of chondrosarcoma mimicking a sellar and suprasellar mass with parasellar extension. A 40 yr woman presented with decreasing visual acuity and headache. Magnetic resonance (MR) image revealed a cystic sellar and suprasellar mass with parasellar extension showing mild enhancing solid component. It favored the diagnosis of craniopharyngioma. The patient underwent trans-sphenoidal partial resection of the tumor resulting in removal of the sellar mass. However, the suprasellar mass could not be excised completely due to limited surgical field. The pathologic diagnosis was chondrosarcoma. Eight months after the operation, pterional approach was performed to remove the remaining mass. Intraoperative findings confirmed that the mass originated from dorsum sellae.  PMID:27499779

  8. Pituitary autoimmunity: 30 years later

    PubMed Central

    Caturegli, Patrizio; Lupi, Isabella; Landek-Salgado, Melissa; Kimura, Hiroaki; Rose, Noel R.

    2012-01-01

    Pituitary autoimmunity encompasses a spectrum of conditions ranging from histologically proven forms of lymphocytic hypophysitis to the presence of pituitary antibodies in apparently healthy subjects. Hypophysitis is a rare but increasingly recognized disorder that typically presents as a mass in the sella turcica. It mimics clinically and radiologically other non-secreting sellar masses, such as the more common pituitary adenoma. Hypophysitis shows a striking temporal association with pregnancy, and it has been recently described during immunotherapies that block CTLA-4. Several candidate pituitary autoantigens have been described in the last decade, although none has proven useful as a diagnostic tool. This review summarizes the advances made in the field since the publication of the first review on pituitary autoimmunity, and the challenges that await clarification. PMID:18774118

  9. Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves.

    PubMed

    Kim, Soo Ryang; Kanda, Fumio; Kobessho, Hiroshi; Sugimoto, Koji; Matsuoka, Toshiyuki; Kudo, Masatoshi; Hayashi, Yoshitake

    2006-11-01

    We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-year-old woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI) disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

  10. [Psychopathology and neuro-ophthalmology in meningioma of the olfactory groove].

    PubMed

    Lange, E; Bräunig, K P; Fötzsch, R

    1982-01-01

    In 14 patients with a surgically nad histopathologically verified meningioma of the olfactory nerve groove (OGM) (12 women, 2 men), clinical findings and diagnosis were analysed, especially with respect to neuropathology and psychopathology. The apodictic theorem that an OGM leads to a Foster-Kennedy syndrome as well as to a psychopathological orbital brain syndrome cannot be maintained. The Foster-Kennedy syndrome does not occur in a characteristically high incidence, and psychopathologically an orbital brain syndrome can only be diagnosed in case of an anterior location of the OGM. The more the OGM shows starting point or growth development to or from the anterior chiasmal angle, the more is resembles that psychopathological syndrome that we have found and described for the meningioma of the Tuberculus sellae.

  11. Analysis of general facial growth, maxillary and mandibular growth and treatment changes ("Structural analysis").

    PubMed

    Nielsen, Ib Leth

    2011-12-01

    General facial growth has in the past mostly been analyzed by superimposing on the nasion-sella line using the so-called "best fit" technique. Best fit approaches have also been used to analyze maxillary and mandibular growth and treatment changes. In this article we shall present a more reliable method for analyzing the changes that occur as a result of growth and treatment using the so-called "Structural technique" developed by Björk et al. This technique is based on the results of studies of facial growth using metallic implants over more than 25years. We will discuss how this technique can be applied without the benefit of implants to provide a better and more reliable understanding of the skeletal and dental changes in treated cases.

  12. 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

  13. Diagnostic performance of various cephalometric parameters for the assessment of vertical growth pattern

    PubMed Central

    Ahmed, Maheen; Shaikh, Attiya; Fida, Mubassar

    2016-01-01

    ABSTRACT Introduction: Multiple cephalometric analyses are used to diagnose vertical skeletal facial discrepancy. A multitude of times, these parameters show conflicting results, and a specific diagnosis is hard to reach. Objective: Hence, this study aimed to identify the skeletal analysis that performs best for the identification of vertical skeletal pattern in borderline cases. Methods: The sample consisted of 161 subjects (71 males and 90 females; mean age = 23.6 ± 4.6 years). Y-axis, Sella-Nasion to mandibular plane angle (SN.MP), maxillary plane to mandibular plane angle (MMA), Sella-Nasion to Gonion-Gnathion angle (SN.GoGn), Frankfort to mandibular plane angle (FMA), R-angle and facial height ratio (LAFH.TAFH) were used to evaluate vertical growth pattern on lateral cephalograms. The subjects were divided into three groups (hypodivergent, normodivergent and hyperdivergent groups), as indicated by the diagnostic results of the majority of parameters. Kappa statistics was applied to compare the diagnostic accuracy of various analyses. To further validate the results, sensitivity and positive predictive values (PPV) for each parameter were also calculated. Results: SN.GoGn showed a substantial interclass agreement (k = 0.850). In the hypodivergent group, MMA showed the highest sensitivity (0.934), whereas FMA showed the highest PPV (0.964). In the normodivergent group, FMA showed the highest sensitivity (0.909) and SN.GoGn had the highest PPV (0.903). SN.GoGn showed the highest sensitivity (0.980) and PPV (0.87) in the hyperdivergent group. Conclusions: SN.GoGn and FMA were found to be the most reliable indicators, whereas LAFH.TAFH is the least reliable indicator in assessing facial vertical growth pattern. Hence, the cephalometric analyses may be limited to fewer analyses of higher diagnostic performance. PMID:27653263

  14. The history of pituitary surgery for Cushing disease.

    PubMed

    Mehta, Gautam U; Lonser, Russell R; Oldfield, Edward H

    2012-02-01

    Although he never performed a pituitary operation for the disease, Harvey Cushing was the first to describe and treat patients with Cushing disease (CD). Other surgeons at the time were reluctant to operate on the pituitary due to the normal sella on skull radiographs in CD and the unclear etiology of the disorder. To better define and understand factors influencing the history of pituitary surgery for CD, the authors analyzed historical texts related to CD biology, diagnosis, and treatment. Cushing's monograph on basophilic pituitary adenomas and cortisol excess appeared in 1932. One year later in 1933, Alfred Pattison performed the first successful pituitary operation for CD by implanting radon seeds in the sella. Resection of a pituitary adenoma for CD was attempted 1 month later in 1933 by Howard Naffziger, resulting in only transient improvement that corresponded to the lack of tumor in the resected tissue. Soon thereafter, Susman in 1935 and Costello in 1936 described pituitary basophilic adenomas at autopsy in patients without premorbid endocrinopathy. They concluded that the adrenal gland was the cause of CD, which resulted in a 3-decade abandonment of pituitary surgery for CD. Jules Hardy in 1963 used the operating microscope to perform the first selective removal of an adrenocorticotropic hormone (ACTH)-secreting microadenoma, which established a pituitary cause and defined the modern treatment of CD. Subsequent reports by Hardy, Laws, and Wilson resulted in widespread acceptance of pituitary surgery for CD. Initial reluctance to operate on the pituitary for CD was multifaceted and included general uncertainty surrounding the etiology of Cushing syndrome as well as a lack of early surgical success, both due to the small size of ACTH-secreting adenomas. Selective removal of ACTH-secreting adenomas identified the source of CD and ended the delay in acceptance of pituitary surgery for CD. PMID:21962161

  15. 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

  16. The rhinologist and the management of pituitary disease.

    PubMed

    Kenan, P D

    1979-02-01

    Since the early days of pituitary surgery, a variety of transnasal approaches have been used to gain access to the sella turcica. Each of these approaches requires crossing the sphenoid sinus, hence the transsphenoidalnoidal designation of these methods. Since the growth and refinement of microsurgery as a distinct surgical discipline, there has been a coincidental maturation of transsphenoidal microsurgical techniques for the management of a variety of pituitary disorders. The present paper reviews the historical events leading to the current methods of transphenoidal pituitary surgery. Detailed descriptions of each method are given, with the advantages and disadvantages of each. The author's method is described and illustrated in a step-by-step manner, and the criteria which determine operability by transsphenoidal versus transfrontal craniotomy are discussed. The advantages which transsphenoidal techniques offer over transfrontal methods are emphasized. The paper deals with pituitary disorders on a clinical and pathological basis. The work-up of pituitary lesions is discussed, with a detailed presentation of the endocrine evaluation. Further emphasis is given to the value of tomography of the sphenosellar complex in planning operative approaches for removal of pituitary lesions, particularly when the lesion is a so-called "microadenoma," producing no obvious expansion nor erosion of the cellar floor. The author's experience in the management of 125 lesions of the pituitary or associated sella turcica is presented and complications are discussed. Because of the relatively brief period of follow-up, no conclusive evidence can be offered regarding cures in the author's series. However, on the basis of reported experience by others working in the same area, one may expect acceptable long-term improvement or cures in selected pituitary lesions operated on by transshpenoidal methods. The team management of pituitary disorders is stressed. In particular, emphasis is

  17. A history of pituitary pathology.

    PubMed

    Asa, Sylvia L; Mete, Ozgur

    2014-03-01

    The history of pituitary pathology is a long one that dates back to biblical times, but the last 25 years have represented an era of "coming of age." The role of the pituitary in health and disease was the subject of many studies over the last century. With the development of electron microscopy, immunoassays, and immunohistochemistry, the functional alterations associated with pituitary disease have been clarified. The additional information provided by molecular genetic studies has allowed progress in understanding the pathogenesis of pituitary disorders. Nevertheless, many questions remain to be answered. For example, pathologists cannot morphologically distinguish locally aggressive adenomas from carcinomas when tumor is confined to the sella. Sadly, basal cell carcinoma, the most common carcinoma of skin, usually causes less morbidity than pituitary adenomas, which occur in almost 20 % of the general population, can cause significant illness and even death, and yet are still classified as benign. The opportunity to increase awareness of the impact of these common lesions on quality of life is the current challenge for physicians and patients. We anticipate that ongoing multidisciplinary approaches to pituitary disease research will offer new insights into diseases arising from this fascinating organ.

  18. Detection of transgenerational barium dual-isotope marks in salmon otoliths by means of LA-ICP-MS.

    PubMed

    Huelga-Suarez, Gonzalo; Fernández, Beatriz; Moldovan, Mariella; García Alonso, J Ignacio

    2013-03-01

    The present study evaluates the use of an individual-specific transgenerational barium dual-isotope procedure and its application to salmon specimens from the Sella River (Asturias, Spain). For such a purpose, the use of laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) in combination with multiple linear regression for the determination of the isotopic mark in the otoliths of the specimens is presented. In this sense, a solution in which two barium-enriched isotopes ((137)Ba and (135)Ba) were mixed at a molar ratio of ca. 1:3 (N Ba137/N Ba135) was administered to eight returning females caught during the spawning period. After injection, these females, as well as their offspring, were reared in a governmental hatchery located in the council of Cangas de Onís (Asturias, Spain). For comparison purposes, as well as for a time-monitoring control, egg and larva data obtained by solution analysis ICP-MS are also given. Otoliths (9-month-old juveniles) of marked offspring were analysed by LA-ICP-MS demonstrating a 100 % marking efficacy of this methodology. The capabilities of the molar fraction approach for 2D imaging of fish otoliths are also addressed.

  19. 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

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves.

    PubMed

    Cho, Kwang Ho; Rodríguez-Vázquez, Jose Francisco; Han, Eui Hyeog; Verdugo-López, Samuel; Murakami, Gen; Cho, Baik Hwan

    2010-09-20

    Development of the meninges in and around the plica ventralis encephali has not been well documented. A distinct mesenchymal structure, the so-called plica ventralis encephali, is sandwiched by the fetal mesencephalic flexure. We histologically examined paraffin-embedded sections from 18 human embryos and fetuses at 6-12 weeks of gestation. In the loose tissues of the plica, the first meninx appeared as a narrow membrane along the oculomotor nerve at 7-8 weeks. Subsequently, the plica ventralis evolved into 3 parts: bilateral lateral mesenchymal condensations and a primitive membranous meninx extending between. Notably, the topographical anatomy of the oculomotor, trochlear and trigeminal nerves did not change: the oculomotor nerve ran along the rostral aspect of the membranous meninx, the trigeminal nerve ran along the caudal side of the lateral mesenchymal condensation, and the trochlear nerve remained embedded in the lateral condensation. Up to 9-10 weeks, the lateral mesenchymal condensations became tongue-like folds; i.e., the primitive form of the tentorium cerebelli, while the membranous meninx became the diaphragma sellae. The falx cerebri seemed to develop from the tongue-like folds. Overall, the final tentorium cerebelli corresponded to the regressed plica ventralis, while the parasellar area originated from the base of the plica and other tissues along the ventral aspects of the basisphenoid and basioccipital.

  5. 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

  6. Chondroblastoma of the Clivus: Case Report and Review.

    PubMed

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

    2015-11-01

    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.

  7. Pituitary function and growth hormone dynamics in acromegaloidism.

    PubMed

    Mims, R B

    1978-12-01

    Acromegaloidism is a condition which resembles acromegaly by its clinical manifestations but is not due to pituitary or hypothalamic dysfunction. Twenty patients were diagnosed as having this disorder and the results from studying growth hormone (GH) responses in 15 patients (11 women and four men) were included in this report. Clinical manifestations closely resembled those of acromegalics, including history of progressive changes, acral enlargement, visual disturbances, abnormal visual fields in four patients, and sella turcica enlargement in two patients. The glucose tolerance test (GTT) was abnormal in 12/15 patients, 13/15 were > 10 percent obese, 8/15 had hypertension, 7/15 had large-statured relatives, but lactorrhea was absent in all patients. The mean serum GH concentration was 2.2 ng/ml, which suppressed to 0.6 ng/ml during the GTT; increased to 24 ng/ml during hypoglycemia; and increased to 10.3 ng/ml after L-dopa ingestion. Other pituitary hormones (LH, FSH, TSH, prolactin), the metyrapone test, 24-hour random and nocturnal sleeping GH concentrations were normal. These GH values and responses helped to differentiate acromegaloidism from treated and untreated acromegaly. The pathogenesis of acromegaloidism was not determined, but somatomedin studies may prove helpful in further defining this disorder. PMID:731719

  8. 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

  9. 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

  10. 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.

  11. 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

  12. Hyperprolactinemia: etiology, diagnosis, and management.

    PubMed

    Mah, Peak Mann; Webster, Jonathan

    2002-11-01

    Hyperprolactinemia is the most common endocrine disorder of the hypothalamic-pituitary axis. A prolactinoma is the most common cause of chronic hyperprolactinemia once pregnancy, primary hypothyroidism, and drugs that elevate serum prolactin levels have been excluded. Patients can present with hypogonadism, infertility, galactorrhea, osteopenia, and mass effects of the tumor. When hyperprolactinemia is confirmed, a cause for the disorder needs to be sought. This involves a careful history and examination, followed by laboratory tests and diagnostic imaging of the sella turcica. The goals of treatment are to normalize prolactin levels, restore gonadal function, and reduce the effects of chronic hyperprolactinemia. Dopamine agonists are the treatment of choice for the majority of patients. Transsphenoidal surgery is usually reserved for patients who are intolerant of or resistant to dopamine agonists or when hyperprolactinemia is caused by non-prolactin-secreting tumors compressing the pituitary stalk. Cabergoline has been shown to be more effective and better tolerated than bromocriptine. However, there are more data on the safety of the latter drug during pregnancy and bromocriptine, therefore, remains the treatment of choice in hyperprolactinemic women wishing to conceive.

  13. Atypical presentations of solitary fibrous tumors of the central nervous system: an analysis of unusual clinicopathological and outcome patterns in three new cases with a review of the literature.

    PubMed

    Pakasa, Nestor M; Pasquier, Basile; Chambonnière, Marie-Laure; Morrison, Alan L; Khaddage, Abir; Perret, Anne Gentil; Dumollard, Jean Marc; Barral, Fabrice G; Péoc'h, Michel

    2005-07-01

    Central nervous system (CNS) solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms recognized less than a decade ago. Approximately 60 cases of SFT have been reported in the central nervous system. We describe three atypical SFTs of the CNS, two intracranial and one within the spine. One intracranial SFT arose from the sella turcica and expanded into the suprasellar areas. It relapsed twice during the 3 years following partial resection, and the MiB 1 labeling index steadily increased without obvious malignant transformation. The second SFT arose from the confluence of the sinuses, widely invaded the lateral sinus and adjacent bones, had a low MiB 1 index and has not recurred after 5 years. The intraspinal tumor occurred at T5-T7 in a patient with multiple café-au-lait spots, was predominantly myxoid and developed a second similar lesion at S3-S5 14 years later. The MiB 1 index was lower in the second tumor. Immunohistochemistry confirmed that all were SFTs. These atypical presentations gave us an opportunity to provide further information about the natural histological course of CNS SFTs.

  14. Transsphenoidal microsurgery for Cushing's disease.

    PubMed

    Tagliaferri, M; Berselli, M E; Loli, P

    1986-09-01

    The study shows the results of transsphenoidal microsurgery in 23 patients with Cushing's disease (CD). Out of the 21 patients with tumour confined to the sella, 18 who had selective adenomectomy, and 1 who underwent total hypophysectomy had correction of hypercortisolism. None of the patients with extrasellar extension of the tumour was cured. In 2 cases no adenoma was found intra-operatively. Post-operative hypoadrenalism was documented in all the patients who remitted clinically. By 3-26 months after surgery, adequate cortisol secretion was found in 12 patients, nine of whom regained diurnal variation of cortisol secretion and ten cortisol responsiveness to hypoglycaemia; a normal or near normal response of cortisol to CRF was documented in 11 out of 17 patients tested. Thyroid and gonadal function was restored in all but two patients in clinical remission, whereas GH responsiveness to hypoglycaemia appeared impaired in 11. Two patients had recurrence of the disease 2 and 3 years, respectively, after successful adenomectomy. In our experience transsphenoidal selective adenomectomy is an effective treatment for most patients with CD; additional therapeutic approaches should be considered for patients bearing pituitary tumours with extrasellar extension, whose surgical outcome is often disappointing.

  15. [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.

  16. [ Study of prolactin and blood gonadotropins in amenorrheas-galactorrhea. Dynamic exploation in 13 cases].

    PubMed

    Schaison, G; Nathan, C; L'Hermite, M; Gilbert-Dreyfus

    1975-03-01

    A study of the secretion of prolactin and plasma gonadotrophins was carried out comparatively in 3 groups of patients: histologically confirmed prolactin adenoma (group 1), idiopathic or iatrogenic amenorrhoea/galactorrhoea syndrome (group 2), empty sella turcica syndrome (group 3). The last group differs fundamentally from the two previous by the presence of a normal basal LH and FSH levels and normal LH-RH stimulation. Prolactin is not increased. It may be suppressed by L-dopa and stimulated by TRH. There exist no differences, apart from neuroradiological criteria, between the other two groups. The level of LH is slightly decreased but the response to LRH is positive, this effect often being more clear on FSH. Prolactin levels are raised, this no doubt explaining the negative response to TRH and chlorpromazine stimulation. Suppression by L-dopa is positiive, reflecting the absence of autonomy of prolactin adenomata. The water load test is unsatisfactory. There exists at the present time no method sufficiently discriminating to exclude the presence of a tumour at the origin of an amenorrhoea-galactorrhoea syndrome.

  17. Three-dimensional cephalometry: a method for the identification and for the orientation of the skull after cone-bean computed tomographic scan.

    PubMed

    Frongia, Gianluigi; Bracco, Pietro; Piancino, Maria Grazia

    2013-05-01

    The aims of this work were (1) to describe a method to identify new skeletal landmarks useful to define the reference system to orient the skull in a new position after cone-bean computed tomographic scan and (2) to demonstrate the reliability of this new method.Ten orthognathic patients (5 male, 5 female; mean [SD] age, 18.9 [1.2] years) underwent the cone-bean computed tomographic scan before surgery. Seven 3-dimensional skeletal measurements derived from 4 skeletal point of construction (C) (right, left, and median orbital C, and sella C) have been used for this study. Reliability has been calculated using Pearson correlation coefficient tests.Intraobserver reliability was 0.9999 for operator A (T1-T2) and 0.9999 for operator B (T1-T2); interobserver reliability was 0.9999 between the first (T1-T1) measurement and 0.9999 between the second (T2-T2).The original method is able to reduce the variability of landmark identification due to the variability of the human anatomy and the influence of the human error in cephalometric analysis. The innovation of this new method is the real possibility to use the anatomical structures in a 3-dimensional way, enhancing the reliability of the reference points.

  18. Embryological Consideration of Dural Arteriovenous Fistulas.

    PubMed

    Tanaka, Michihiro

    2016-09-15

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falco-tentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  19. 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.

  20. 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.

  1. A Histologically Diagnosed Case with Infantile Osteopetrosis Complicated by Hypopituitarism

    PubMed Central

    Diniz, Gulden; Olukman, Ozgur; Calkavur, Sebnem; Buyukinan, Muammer; Altay, Canan

    2015-01-01

    Malignant infantile osteopetrosis is a rarely seen severe disorder which appears early in life with general sclerosis of the skeleton. It is caused by functionally defective osteoclasts which fail to resorb bone. Affected infants can exhibit a wide spectrum of clinical manifestations including impaired hematopoiesis, hepatosplenomegaly, visual impairment, and hypocalcemia. With the exception of secondary hyperparathyroidism, involvement of the endocrine system seems to be quite rare. Hypopituitarism is defined as underproduction of the growth hormone in combination with deficiencies of other pituitary hormones. Any lesion that damages hypothalamus, pituitary stalk, or anterior pituitary can cause secondary hypopituitarism. In this report, we presented a rare combination of malignant infantile osteopetrosis and secondary hypopituitarism in a newborn who presented predominantly with endocrinological symptoms. This is the first case report of malignant infantile osteopetrosis accompanied by hypopituitarism secondary to sclerosis of the sella turcica. On the other hand, this is a very interesting case which was diagnosed based on histological examination of bone marrow biopsy specimens despite lack of any clinical suspicion. PMID:26576309

  2. 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

  3. 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

  4. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study.

    PubMed

    Williams, M D; Sarver, D M; Sadowsky, P L; Bradley, E

    1997-12-01

    A prospective study of 28 growing children (mean age of 8 years 3 months) with Class III malocclusions was consecutively treated using rapid maxillary expansion and maxillary protraction. All patients were treated from a negative overjet to a positive overjet and from a Class III dental malocclusion to a Class I dental relationship. For each patient, a lateral cephalogram was taken before treatment (T1), immediately posttreatment (T2), and after an observation period (T3) averaging 2 years 5 months. Using analysis of variance, the cephalograms were analyzed to determine skeletal and dental changes resulting from treatment. Long-term changes (2 years 5 month observation period) were also evaluated. Results showed that immediately posttreatment, the maxilla moved anteriorly a mean of 1.54 mm and Sella-Nasion-A point increased 0.87 degree. The maxillary teeth moved anteriorly 2.73 mm and proclined 5.23 degrees, while the mandible rotated in a downward and backward direction. Long-term, the anterior position of the maxilla was maintained, but some of the Class III correction was lost because of mandibular growth. Comparison of this study's results to Riolo's longitudinal Class I data showed that, overall, rapid palatal expansion and maxillary protraction produced a small orthopedic effect with a moderate dentoalveolar effect which together contributed to the correction of the Class III malocclusion.

  5. Clinical and molecular studies on two further families with Simpson-Golabi-Behmel syndrome.

    PubMed

    Rodríguez-Criado, Germán; Magano, Luis; Segovia, Mabel; Gurrieri, Fiorella; Neri, Giovanni; González-Meneses, Antonio; Gómez de Terreros, Ignacio; Valdéz, Rita; Gracia, Ricardo; Lapunzina, Pablo

    2005-10-15

    The Simpson-Golabi-Behmel syndrome (SGBS) (OMIM 312870) is an overgrowth/multiple congenital anomalies syndrome caused by a semi-dominant X-linked gene encoding glypican 3 (GPC3). It shows great clinical variability, ranging from mild forms in carrier females to lethal forms with failure to thrive in males. The most consistent findings in SGBS are pre- and postnatal macrosomia, characteristic facial anomalies and abnormalities affecting the internal organs, skeleton, and on some occasions, mental retardation of variable degree. SGBS is also associated with an increased risk of developing embryonal tumors, mostly Wilms and liver tumors. We describe two molecularly-confirmed families with SGBS. All patients had typical manifestations of SGBS including some female relatives who had minor manifestations of the disorder. Some patients had novel findings such as a deep V-shaped sella turcica and six lumbar vertebrae. Molecular studies in affected patients showed a deletion of exon 6 in family 1 and an intronic mutation in family 2.

  6. Chiasmal optic glioma after radiation therapy. Neuro-ophthalmologic/pathologic correlation

    SciTech Connect

    Parker, J.C. Jr.; Smith, J.L.; Reyes, P.; Vuksanovic, M.M.

    1981-03-01

    A 16-year-old white girl with neurofibromatosis was documented as having progressive visual loss in both eyes over 3 years before diagnosis of a chiasmal glioma. She was then treated with supervoltage irradiation to the sella and parasellar area. Bitemporal fields measuring 5 x 5 cm each were initially used, and source skin distance of 80 cm with coplanar opposing technique was used whereby each field was treated daily to a midplane dose of 186 rads. The patient received a cumulative tumor dose over the 5-week course of 4680 rads. She tolerated this well, and her visual function was stabilized thereafter for over a year. Two years following therapy, she expired suddenly and unexpectedly at home. At autopsy, there was no radionecrosis in the brain or optic nerves, but minimal radiation changes were seen in the tumor. Extensive local invasion was seen in the entire chiasm, adjacent optic tracts and hypothalamus. In addition, other disparate small fibrillary astrocytic gliomas were found in the optic radiations, midbrain, and left anterior midfrontal lobe. This patient therefore documents clinically progressive visual deterioration before irradiation therapy, and palliative visual function stability for well over a year after irradiation therapy. The patient also demonstrates the difficulty in treating a locally aggressive optic chiasmal glioma, its infiltrative nature, and the multifocality of other unsuspected neural tumors in neurofibromatosis.

  7. 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

  8. Sellar Reconstruction and Rates of Delayed Cerebrospinal Fluid Leak after Endoscopic Pituitary Surgery

    PubMed Central

    Sanders-Taylor, Chris; Anaizi, Amjad; Kosty, Jennifer; Zimmer, Lee A.; Theodosopoulos, Phillip V.

    2015-01-01

    Objectives Delayed cerebrospinal fluid (CSF) leaks are a complication in transsphenoidal surgery, potentially causing morbidity and longer hospital stays. Sella reconstruction can limit this complication, but is it necessary in all patients? Design Retrospective review. Setting Single-surgeon team (2005–2012) addresses this trend toward graded reconstruction. Participants A total of 264 consecutive patients with pituitary adenomas underwent endoscopic transsphenoidal resections. Sellar defects sizable to accommodate a fat graft were reconstructed. Main outcomes Delayed CSF leak and autograft harvesting. Results Overall, 235 (89%) had reconstruction with autograft (abdominal fat, septal bone/cartilage) and biological glue. Delayed CSF leak was 1.9%: 1.7%, and 3.4% for reconstructed and nonreconstructed sellar defects, respectively (p = 0.44). Complications included one reoperation for leak, two developed meningitis, and autograft harvesting resulted in abdominal hematoma in 0.9% and wound infection in 0.4%. Conclusion In our patients, delayed CSF leaks likely resulted from missed intraoperative CSF leaks or postoperative changes. Universal sellar reconstruction can preemptively treat missed leaks and provide a barrier for postoperative changes. When delayed CSF leaks occurred, sellar reconstruction often allowed for conservative treatment (i.e., lumbar drain) without repeat surgery. We found universal reconstruction provides a low risk of delayed CSF leak with minimal complications. PMID:26225317

  9. Gorlin–Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature

    PubMed Central

    Lata, Jeevan; Verma, Nitin; Kaur, Amandeep

    2015-01-01

    Objective: In Indian scenario, Gorlin–Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. Materials and Methods: The diagnostic findings of Gorlin–Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. Results: The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Conclusions: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested. PMID:26604574

  10. Chondroblastoma of the Clivus: Case Report and Review.

    PubMed

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

    2015-11-01

    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

  11. 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

  12. The Hoshino wooden skeleton, the first wooden model of a human skeleton, made during the Edo era in Japan.

    PubMed

    Kataoka, Katsuko; Suzaki, Etsuko; Ajima, Noriaki

    2007-03-01

    The wooden model of the human skeleton, called the wooden skeleton, is a distinguished original craft object from the Edo era, in Japan, when medical doctors were unable to keep a human skeleton for study and teaching purposes. There are three types of wooden skeletons: (i) Hoshino made in 1792; (ii) Kagami made by 1810; and (iii) Okuda made around 1820. The former two are of adult males and the latter is of a female. The wooden skeletons were made with surprising accuracy compared with figures that appeared in the medical books available in Japan at that time, which suggests a scientific readiness of the doctors and the skill of the craftsmen. In the cases of the Hoshino and Kagami wooden skeletons, it is hard to consider that all wooden bones were assembled to show the entire body. Conversely, the Okuda wooden skeletons were made for showing in the sitting position. The skull of the Hoshino wooden skeleton is of special interest: the skull cap was not cut, yet the internal structures of the skull, such as the sella turcica, foramina for nerves and vessels, and the sulci for venous sinuses, were made with considerable accuracy. The skull caps of the Kagami and Okuda wooden skeletons were cut, as those used in modern medical education.

  13. Hermann Schloffer and the origin of transsphenoidal pituitary surgery.

    PubMed

    Schmidt, Richard F; Choudhry, Osamah J; Takkellapati, Ramya; Eloy, Jean Anderson; Couldwell, William T; Liu, James K

    2012-08-01

    A little over a century ago, in 1907, at the University of Innsbruck, Hermann Schloffer performed the first transsphenoidal surgery on a living patient harboring a pituitary adenoma. Schloffer used a superior nasal route via a transfacial lateral rhinotomy incision. This was perhaps his greatest academic contribution to neurosurgery. Despite the technological limitations of that time, Schloffer's operation was groundbreaking in that it laid the foundation for future development and refinement of transsphenoidal pituitary surgery, influencing prominent surgeons such as Oskar Hirsch and Harvey Cushing. Even after undergoing multiple modifications and a brief fall into obscurity, the transsphenoidal approach has endured through generations of surgeons and remains the preferred approach for lesions of the sella turcica to this day. Although Schloffer performed primarily abdominal surgery in his practice, his contributions to the transsphenoidal approach have had a lasting impact in the field of pituitary and skull base surgery. The authors review the life and career of Hermann Schloffer, the surgical details of his transsphenoidal operation, and the legacy that it has left on the field of pituitary surgery. PMID:22853836

  14. Suppression of Tinnitus in a Patient with Unilateral Sudden Hearing Loss: A Case Report

    PubMed Central

    Fioretti, Alessandra; Peri, Giorgia; Eibenstein, Alberto

    2012-01-01

    We describe a case of a 67-year-old woman with severe disabling right-sided tinnitus, mild hyperacusis, and headache. The tinnitus was associated with sudden right hearing loss and vertigo, which occurred about 18 months before. Magnetic resonance imaging (MRI) resulted in normal anatomical structures of the cochlea and of the cranial nerves showing a partial empty sella syndrome with suprasellar cistern hernia. Angio-MR revealed a bilateral contact between the anterior-inferior cerebellar artery (AICA) and the acoustic-facial nerve with a potential neurovascular conflict. Surgery was considered unnecessary after further evaluations. The right ear was successfully treated with a combination device (hearing aid plus sound generator). Shortly after a standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and headache which completely disappeared at the follow-up evaluation after 3, 6, and 12 months. This paper demonstrates that the combination device resulted in a complete tinnitus and hyperacusis suppression in a patient with unilateral sensorineural sudden hearing loss. Our paper further supports the restoration of peripheral sensory input for the treatment of tinnitus associated with hearing loss in selected patients. PMID:23227400

  15. 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

  16. 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.

  17. 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

  18. 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

  19. [Juvenile nasopharyngeal fibroma. Report of experiences].

    PubMed

    Weidenbecher, M

    1984-04-01

    The juvenile nasopharyngeal angiofibroma is a rare and histologically benign tumour of the adolescent male. The aetiology and site of origin are unknown. The diagnosis can easily be made by the symptoms, the typical angiographic pattern and the endoscopic picture. Complete surgical extirpation is superior to all other modalities such as radiotherapy and hormonal treatment. To reduce the enormous blood flow into the tumour, the ligation of the external carotid artery, or the embolisation of the feeding vessels are the best presurgical methods. The technique of tumour removal differs according to the size of the tumour. A great therapeutic problem are those tumours which grow through the skull base and invade the sella, the optic nerve or the cavernous sinus. These tumours should be removed as radically as possible. Small areas of intracranial tumour could remain in order to preserve the optic nerve or the pituitary. These small areas respond very well to 4000 rads. Of 14 patients treated between 1972 and 1981, 12 tumours (types I and II) could be removed completely (recurrence rate 0%), 2 neoplasms ( typ III and IV) which were removed incompletely, received 4000 rads directed at the intracranial remnant, and showed no tumour progression within 4 and 6 years. The preoperative use of hormones (2 cases) showed no effect on the tumour size, especially not on intraoperative loss of blood.

  20. Huge nasopharyngeal angiofibroma with intracranial extension: change in the dura mater and choice of surgical management.

    PubMed

    Yi, Z X; Li, Z C; Cheng, J M; Zhang, R; Lin, Chang; Zhou, A D; Fan, Z M

    2007-11-01

    We aimed to review (1) the imaging changes in the dura mater in cases of huge, lobulated juvenile nasopharyngeal angiofibroma, and (2) the choice of surgical management. Imaging from four cases of juvenile nasopharyngeal angiofibroma showed extrapharyngeal extension of the tumour. The sphenoid sinus, sella turcica and clivus were extensively eroded, and the tumour had spread deep into the cranial fossa. In three cases, intracranial exploration was performed to treat the intracranial tumour lobule. Subsequently, the tumours were removed using extracranial approaches. No perforation of the dura mater was found in these three cases, although the dura mater in the superior orbital fissure was congested, haemorrhagic and solid. Pre-operative imaging for two cases (i.e. the first operation for one and the second operation for the other) revealed no dura mater perforation. A transantral approach via a midfacial degloving incision was used to remove these tumours completely. We conclude that change in the dura mater is a crucial indication for the choice of management. If the dura mater is intact, a transantral approach via a midfacial degloving incision may remove the tumour successfully.

  1. 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.

  2. Skeletal manifestations of juvenile hypothyroidism and the impact of treatment on skeletal system.

    PubMed

    Gutch, Manish; Philip, Rajeev; Philip, Renjit; Toms, Ajit; Saran, Sanjay; Gupta, K K

    2013-10-01

    Thyroid hormone mediates growth and development of the skeleton through its direct effects and through its permissive effects on growth hormone. The effect of hypothyroidism on bone is well described in congenital hypothyroidism, but the impact of thyroid hormone deficiency on a growing skeleton, as it happens with juvenile hypothyroidism, is less defined. In addition, the extent to which the skeletal defects of juvenile hypothyroidism revert on the replacement of thyroid hormone is not known. A study was undertaken in 29 juvenile autoimmune hypothyroid patients to study the skeletal manifestations of juvenile hypothyroidism and the impact of treatment of hypothyroidism on the skeletal system of juvenile patients. Hypothyroidism has a profound impact on the skeletal system and delayed bone age, dwarfism, and thickened bands at the metaphyseal ends being the most common findings. Post treatment, skeletal findings like delayed bone age and dwarfism improved significantly, but there were no significant changes in enlargement of sella, presence of wormian bones, epihyseal dysgenesis, vertebral changes and thickened band at the metaphyseal ends. With the treatment of hypothyroidism, there is an exuberant advancement of bone age, the catch up of bone age being approximately double of the chronological age advancement.

  3. Embryological Consideration of Dural Arteriovenous Fistulas

    PubMed Central

    TANAKA, Michihiro

    2016-01-01

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falcotentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  4. [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

  5. Acromegaly: Role of Surgery in the Therapeutic Armamentarium

    PubMed Central

    Guinto, Gerardo; Abdo, Miguel; Zepeda, Erick; Aréchiga, Norma; Mercado, Moisés

    2012-01-01

    Acromegaly is a complex disease that requires the intervention of a multidisciplinary team. The most frequent clinical manifestations are growing of distal parts of the body and some areas of the face. Patients may also present arterial hypertension, diabetes mellitus, colonic polyps, cardiomegaly, neurological and endocrine changes secondary to the presence of a GH-secreting tumor in pituitary or extrapituitary origin, or eutopic hypothalamic GHRH hypersecretion and peripheral GHRH hypersecretion. Surgery is the first treatment used for most patients, regardless of the cause. In the great majority of cases, pituitary tumor can be removed through a transsphenoidal approach. Craniotomy is reserved for those cases with giant tumors, particularly when they grow toward the middle or posterior cranial fossa. Best surgical results are obtained when the tumor is confined into the sella turcica or if it has a regular suprasellar extension. When the disease cannot be controlled with surgery, medical treatment is indicated. Somatostatin analogues are included as the first line of medication, followed by dopamine agonist and growth hormone receptors antagonists. Radiation therapy can be also indicated in two main forms for residual tumor with medically refractory patients: radiosurgery for small tumors or fractionated stereotactic radiotherapy for larger ones. PMID:23209463

  6. [Active acromegaly and gigantism: some clinical characteristics of 50 patients].

    PubMed

    Pumarino, H; Oviedo, S; Michelsen, H; Campino, C

    1991-08-01

    50 patients with autonomous growth hormone excess (48 with adult acromegaly and 2 with gigantism) were studied between 1966 to 1986 (2.38 pts/year). Characteristic clinical presentation, an increase in growth hormone (GH) uninhibited by glucose, and/or hyperphosphemia and hyperhydroxiprolinuria were present in all patients. No cases of hypercalcemia were recorded. Phosphemia was increased in 55.8%, alkaline phosphatases in 61.7%, calciuria in 26.9% and hydroxyprolinuria in 74.2% of the patients. Basal GH was over 5 ng/ml (89.9 DS +/- 170.9) in 42 pts, and in 37 was not suppressed after glucose administration, 38% had an increased (paradoxical response) and 62% a flat response (less than 50% change of basal values). TRH test was performed in 14 patients, 8 presented an increase in GH titer. Hyperprolactinemia was seen in 4 of 12 patients in whom this hormone was measured. The size of the sella turcica was increased in 93%, and although the larger sellar size correlated to higher levels of GH, correlation was not significant. 20% of the pts had rheumatological disease, 14% goiter, 12% cardiac disease, 26.5% had diastolic hypertension and 4% renal lithiasis (hypercalciuric pts). 38% had hyperglycemia with a diabetic glucose tolerance test and 18% had non-diabetic abnormal glucose tolerance test. PMID:1844771

  7. 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

  8. 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

  9. Diabetes insipidus--diagnosis and management.

    PubMed

    Di Iorgi, Natascia; Napoli, Flavia; Allegri, Anna Elsa Maria; Olivieri, Irene; Bertelli, Enrica; Gallizia, Annalisa; Rossi, Andrea; Maghnie, Mohamad

    2012-01-01

    Central diabetes insipidus (CDI) is the end result of a number of conditions that affect the hypothalamic-neurohypophyseal system. The known causes include germinoma/craniopharyngioma, Langerhans cell histiocytosis (LCH), local inflammatory, autoimmune or vascular diseases, trauma resulting from surgery or an accident, sarcoidosis, metastases and midline cerebral and cranial malformations. In rare cases, the underlying cause can be genetic defects in vasopressin synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits. The diagnosis of the underlying condition is challenging and raises several concerns for patients and parents as it requires long-term follow-up. Proper etiological diagnosis can be achieved via a series of steps that start with clinical observations and then progress to more sophisticated tools. Specifically, MRI identification of pituitary hyperintensity in the posterior part of the sella, now considered a clear marker of neurohypophyseal functional integrity, together with the careful analysis of pituitary stalk shape and size, have provided the most striking findings contributing to the diagnosis and understanding of some forms of 'idiopathic' CDI. MRI STIR (short-inversion-time inversion recovery sequencing) is a promising technology for the early identification of LCH-dependent CDI.

  10. 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

  11. From the radiologic pathology archives: precocious puberty: radiologic-pathologic correlation.

    PubMed

    Chung, Ellen M; Biko, David M; Schroeder, Jason W; Cube, Regino; Conran, Richard M

    2012-01-01

    Precocious puberty represents a unique diagnostic problem in which imaging plays an important role. Development of secondary sex characteristics may result from inappropriate activation of the hypothalamic-pituitary axis with release of gonadotropin, or from gonadotropin-independent secretion of sex steroids by the adrenal glands or gonads. A variety of lesions can manifest with precocious puberty, including various central nervous system (CNS) lesions, adrenal lesions, and sex cord-stromal tumors of the testis or ovary. CNS lesions causing precocious puberty are much more common in boys than in girls and are well evaluated with brain magnetic resonance imaging. Neoplastic (hypothalamic-chiasmatic astrocytoma, suprasellar germinoma) and nonneoplastic (hypothalamic hamartoma, hydrocephalus, trauma, empty sella, infection, congenital midline anomalies) conditions may affect the function of the hypothalamic-pituitary axis. The adrenal cortex may produce sex hormones. Some adrenal cortical neoplasms (ACNs) in patients under 5 years of age are related to a mutation of the tumor suppressor gene p53 and represent a disease that is distinct from ACNs in older children and adults. Adrenal cortical hyperplasia secondary to an enzymatic defect in steroid biosynthesis causes virilization and salt wasting, which usually manifest in the neonatal period; however, milder forms of the disease may manifest in childhood. Female precocious puberty may be caused by an autonomously functioning ovarian cyst or a juvenile granulosa cell tumor of the ovary. Male precocious puberty may be caused by a sex steroid-producing Leydig or Sertoli cell tumor of the testis. Ultrasonography is the primary modality for evaluating the sex organs and may also be used to evaluate for adrenal abnormalities.

  12. The effect of two contrasting forms of orthodontic treatment on the facial profile.

    PubMed

    Looi, L K; Mills, J R

    1986-06-01

    The purpose of this paper was to compare retrospectively the effect on the soft tissues of two contrasting forms of treatment for Class II, Division 1 malocclusion. The first group of 30 persons exhibited uncrowded dentitions and were treated without extractions by means of the Andresen activator. No other appliance was used. The second group was also composed of 30 persons. These subjects were treated with the Begg appliance in its classical form. All of the Begg subjects showed varying amounts of crowding and were treated by extraction of four first premolars. It was believed that the Andresen appliance would maintain the incisors in the most labial position possible, while the Begg group with premolar extractions would involve the maximum lingual incisal movement. These groups were compared with a third group of 22 untreated persons who also exhibited Class II, Division 1 malocclusions. The overjets in the treated groups were successfully reduced in both cases by retraction of the upper incisors; in the Begg group only, retraction of lower incisors was also performed. The upper incisors were retracted substantially more in the Begg group than in the Andresen group, but there was only a slight difference within the two groups in the final position of the upper lip relative to a vertical reference line through sella. There was also a slight difference in the lengths of upper and lower lips within the two treated groups. The lower lip followed the lower incisors more closely in the Begg group. Both upper and lower lips "uncurled" in the treated groups and this probably allowed them to be held together with little strain. There was a wide variation in individual response in all three groups.

  13. 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

  14. Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

    PubMed Central

    Akçakaya, Mehmet Osman; Aras, Yavuz; İzgi, Nail; Gayretli, Özcan; Sabancı, Pulat Akın; Aydoseli, Aydın; Gürses, İlke Ali; Sencer, Altay; Öztürk, Adnan; Hepgül, Kemal

    2015-01-01

    Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements. Materials and Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks. Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62–83 mm); optic chiasm as 76.2 ± 5.4 mm (67–86 mm); anterior communicating artery as 82.6 ± 6.1 mm (71–93 mm); internal carotid artery (ICA) bifurcation as 74.7 ± 6.0 mm (66–84 mm) and the basilar tip as 94.9 ± 7.0 mm (87–111 mm). The mean diameter of the optic canal was 7.4 ± 1.3 mm (6–11 mm), whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7–10 mm). Conclusions: The results of this study showed that the anterior and medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach. PMID:26167020

  15. Norman Dott, Gerard Guiot, and Jules Hardy: key players in the resurrection and preservation of transsphenoidal surgery.

    PubMed

    Patel, Smruti K; Husain, Qasim; Eloy, Jean Anderson; Couldwell, William T; Liu, James K

    2012-08-01

    Developed over a century ago, the transsphenoidal approach to access lesions of the pituitary gland and sella turcica has transformed the field of neurosurgery, largely due to the work of Oskar Hirsch and Harvey Cushing. Furthermore, its use and modification in the early 1900s was perhaps one of Cushing's greatest legacies to skull base surgery. However, Cushing, who had worked relentlessly to improve the transsphenoidal route to the pituitary region, abandoned the approach by 1929 in his pursuit to master transcranial approaches to the suprasellar region. Hirsch and a few other surgeons continued to perform transsphenoidal operations, but they were unable to maintain the popularity of the approach among their peers. During a time when transsphenoidal surgery was on the brink of extinction, a critical lineage of 3 key surgeons--Norman Dott, Gerard Guiot, and Jules Hardy--would resurrect the art, each working to further improve the procedure. Dott, Cushing's apprentice from 1923 to 1924, brought his experiences with transsphenoidal surgery to Edinburgh, Scotland, and along the way, developed the lighted nasal speculum to provide better illumination in the narrow working area. Guiot, inspired by Dott, adopted his technique and used intraoperative radiofluoroscopic technique for image guidance. Hardy, a fellow of Guiot, from Montreal, Canada, revolutionized transsphenoidal microsurgery with the introduction of the binocular microscope and selective adenomectomy. The teachings of these pioneers have endured over time and are now widely used by neurosurgeons worldwide. In this paper, we review the lineage and contributions of Dott, Guiot, and Hardy who served as crucial players in the preservation of transsphenoidal surgery.

  16. 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

  17. Spontaneous recovery from post-traumatic hypopituitarism.

    PubMed

    Iglesias, P; Gómez-Pan, A; Diez, J J

    1996-05-01

    Recovery of the pituitary function from post-traumatic hypopituitarism is an exceptional event. We present the case of a 32 year-old man who was involved in a road traffic accident in which he suffered a severe head injury. Four days following the trauma the patient developed post-traumatic central diabetes insipidus and desmopressin was started. At discharge of the intensive care unit, the patient was referred to us for endocrine assessment. Three months after the head injury, the hormonal evaluation of the hypothalamic-pituitary axis by means of insulin stress test with the simultaneous administration of TRH and GnRH resulted in reduced responses of GH, cortisol, TSH, FSH, and LH with low baseline serum concentrations of free T4 and testosterone. Both serum basal and stimulated PRL concentrations were normal. Magnetic resonance imaging demonstrated deformity of the sella turcica with displacement of the pituitary gland by a post-traumatic retention cyst. A new evaluation of the pituitary function performed 6 months after the trauma showed spontaneous recovery of the gonadal, thyroid and adrenal function. However, GH response was reduced both to insulin-induced hypoglycemia, clonidine and GHRH tests. Presence of normal serum PRL levels, normal PRL response to TRH and reduced GH responses to pituitary and hypothalamic stimuli suggests both hypothalamic and pituitary damage. The present case shows an unusual case of partial spontaneous resolution of a post-traumatic hypopituitarism. Based on this clinical observation we recommend periodic evaluation of the pituitary function in these kind of patients.

  18. 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

  19. Nelson's syndrome: complete remission with cabergoline but not with bromocriptine or cyproheptadine treatment.

    PubMed

    Casulari, Luiz Augusto; Naves, Luciana A; Mello, Paulo A; Pereira Neto, Aldo; Papadia, Carla

    2004-01-01

    A woman affected by Cushing's disease underwent bilateral adrenalectomy followed by radiotherapy of the hypothalamic-pituitary area when she was 18 years old. Thereafter, she used hydrocortisone acetate replacement therapy (35.5 mg divided into two daily doses). At the age of 26 years, the patient exhibited the clinical signs of the Nelson's syndrome, i.e. skin and gingival hyperpigmentation accompanied by amenorrhea, and elevated ACTH plasma levels (2,850 pg/ml, normal range 15-80 pg/ml). The magnetic resonance imaging (MRI) analysis of the sellar region evidenced a pituitary macroadenoma, measuring 14 x 13 mm. The patient was initially treated with cyproheptadine hydrochloride (12 mg/day) for 18 months. There was a partial improvement of the symptoms, with a reduction of the ACTH plasma levels to 112 pg/ml, but without any modification of the tumor mass. Due to sleepiness and weight gain, the cyproheptadine treatment was interrupted and substituted by a cabergoline (0.5 mg twice a week) therapy. Soon after cabergoline was applied an improvement of the clinical symptoms and signs was observed such as a regression of the tumor mass and the normalization of the ACTH plasma titers (38 pg/ml). Later, cabergoline was substituted by bromocriptine (7.5 mg/day) and the plasma levels of ACTH increased again (247 pg/ml), and headache and cutaneous hyperpigmentation were recorded. When cabergoline was reintroduced there was a clinical improvement and normalization of ACTH plasma levels (64 pg/ml). The MRI analysis of the sella region demonstrated a complete remission of the pituitary adenoma. The results obtained show for the first time that a long-term treatment with cabergoline also brings about a complete remission of Nelson's syndrome in the presence of a pituitary macroadenoma.

  20. 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.

  1. Whole body and tomographic scan with 111In-pentetreotide: preliminary data.

    PubMed

    Gregianin, M; Macrì, C; Bui, F; Varotto, L; Zucchetta, P

    1995-12-01

    Since December 1993, in the 1st Nuclear Medicine Service of the University of Padua, eleven somatostatin-receptor scintigraphic studies with 111In-labelled pentetreotide have been performed. The patients (6 men and 5 women, age 28-68, mean 45 years) were affected by a variety of tumors which supposedly express somatostatin receptors: 2 meningotheliomatous meningiomas post-surgery; 2 glucagonomas with liver metastases observed on CT; 2 patients with suspicion of insulinoma; 2 carcinoids, one after surgery; 1 ectopic-ACTH Cushing's syndrome; 1 intracranial germinoma, post-surgery, in whom the study was requested to evaluate a doubtful finding of pulmonary metastatic lesion on CT; and 1 acromegaly showing, on MRI, and empty sella turcica occupied by and extraflexion of the lower portion of the chiasmatic cisterna without signs of adenoma and the sphenoidal sinus occupied by tissue wit inflammmatory characteristics. Somatostatin-receptor whole body scintigraphy was performed 4 and 24 hours after intravenous injection of 110 MBq 111In-pentetreotide (Octreoscan 111); spot images were acquired when judged necessary. In one case of glucagonoma, a tomographic scan (SPECT) was also performed to better evaluate the spatial relationship between the primitive pancreatic tumor and surrounding tissues. Focal accumulation of 111In-pentetreotide was scintigraphically detected in 5 of the 11 cases. Intense uptake of the radiopharmaceutical was observed in the meningiomas, in the glucagonomas with liver metastases, and in the case of acromegaly, corresponding to a GH-secreting adenoma. The negative scans seem to be true negative scans with the possible exception of one patient with a still unconfirmed suspicion of insulinoma, still not confirmed.

  2. Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note.

    PubMed

    Oyama, Kenichi; Fukuhara, Noriaki; Taguchi, Manabu; Takeshita, Akira; Takeuchi, Yasuhiro; Yamada, Shozo

    2014-04-01

    A less invasive transsphenoidal approach with a keyhole dural opening for intrasellar arachnoid cysts is described. This approach was used to address seven sellar cystic lesions with suprasellar extension; they were six intrasellar arachnoid cysts (IACs) and one Rathke's cleft cyst (RCC). In all cases, preoperative MRI revealed cerebrospinal fluid (CSF) intensity on both T1- and T2-weighted images. On preoperative contrast-enhanced MRI, five of the six IACs manifested posterior displacement of the flattened pituitary gland toward the dorsum sellae; one of the six IACs and the RCC exhibited a flattened pituitary gland on the anterior surface of the cyst. Wide cyst cisternostomy through a keyhole dural opening was carried out safely using a microscope with the support of a thin angled endoscope (30° and/or 70°, diameter 2.7 mm). As we aimed to avoid iatrogenic injury of the pituitary function, we found it difficult to obtain a sufficiently wide and precise opening of the cyst wall when the pituitary gland was located on the anterior surface of the cyst wall. Our approach facilitates safe cyst cisternostomy as wide as that obtainable by transcranial manipulation. In addition, CSF leakage is prevented by dural plasty using the fascia lata and stitching with 6-0 monofilament sutures. This technique can be adapted to address various sellar cystic lesions. However, as the posterior or anterior displacement of the normal pituitary gland in the presence of IACs or RCCs, respectively, affects the width of the cyst opening, our technique is more suitable for IACs than RCCs.

  3. Ectopic acromegaly due to a GH-secreting pituitary adenoma in the sphenoid sinus: a case report and review of the literature

    PubMed Central

    2013-01-01

    Background In more than 98% of cases, acromegaly is due to a GH-secreting pituitary adenoma. The term “ectopic acromegaly” includes neuroendocrine tumors secreting GH releasing hormone (GHRH), usually located in the lungs, thymus and endocrine pancreas. Considerably less frequent are cases of ectopic acromegaly due to GH-secreting tumors located out of the pituitary fossa; except for one isolated case of a well-documented GH-secreting lymphoma, the majority of these lesions are located in the sphenoid sinus. Case presentation We present the case of a 45 year old woman with acromegaly whose MRI showed an empty sella without evidence of a pituitary adenoma but revealed a large mass within the sphenoid sinus. She underwent transsphenoidal surgery and the excised sphenoid sinus mass, proved to be a GH-secreting adenoma; the sellar floor was intact and no other lesions were found in the pituitary fossa. She required postoperative treatment with somatostatin analogs and cabergoline for clinical and biochemical control. Conclusions This case highlights the importance of carefully evaluating the structures surrounding the sellar area when a pituitary adenoma is not found with currently available imaging techniques. The finding of an intact sellar floor and duramater lead us to conclude that the patient’s tumor originated de novo from embryological pituitary remnants. Upon a careful review of the literature and a critical evaluation of our case we found neither clinical nor biochemical features that would distinguish an ectopic from the more common eutopically located somatotrophinoma. PMID:24119925

  4. 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

  5. Chromosome 22q deletions in atypical teratoid/rhabdoid tumors in adults.

    PubMed

    Raisanen, Jack; Biegel, Jaclyn A; Hatanpaa, Kimmo J; Judkins, Alexander; White, Charles L; Perry, Arie

    2005-01-01

    Atypical teratoid/rhabdoid tumors (AT/RTs) are rare, malignant brain tumors that usually occur in the posterior fossa. Both AT/RT and the analogous tumor outside the brain, malignant rhabdoid tumor, share a polyphenotypic immunoprofile and frequent 22q deletions with inactivation of the IN11/hSNF5 gene. Reports, so far, indicate that AT/RTs occur almost exclusively in children, most of whom are 5-years-old or less. The rarity of the tumor and the polyphenotypic immunoprofile, characterized by antigen expression that is often patchy, make diagnosis in adults difficult and controversial. We describe three AT/RTs in adults in which the diagnoses were supported by detection of 22q11.2 deletions, INI1 mutation and/or loss of INI1 protein expression. Two patients were female, ages 20 and 31 and one was male, age 45. Two tumors occurred in the sella or sellar region and one in the cerebellum. In all cases, fluorescence in situ hybridization with probes to the BCR (22q11.2) and NF2 (22q12) regions of chromosome 22 revealed single copy deletions of BCR with normal dosages of NF2 and, in all cases, immunohistochemistry demonstrated loss of INI1 protein expression. In one case, a single base pair deletion was detected in the INI1/hSNF5 gene. These molecular findings confirm the occurrence of AT/RTs in adults. Although rare, AT/RT should be considered in the differential diagnosis of poorly differentiated intracranial tumors in adults. PMID:15779233

  6. Effect of cranial irradiation on hypothalamus and pituitary functions.

    PubMed

    Huang, T S; Huang, L S; Tung, C C; Lee, S H; Chen, F W; Huang, S C; Hsieh, T

    1989-07-01

    Hypopituitarism can occur after cranial irradiation for tumors distant from the pituitary gland. Recent studies have suggested that this is hypothalamic in origin. Hypothalamic and pituitary functions were studied in 11 patients, 4 men and 7 women, 4.5 years or more after radiotherapy for nasopharyngeal carcinomas. The estimated average total dose was 5000 cGys for the hypothalamus and pituitary gland. Except for 2 women with amenorrhea and 4 men with impotency, the patients did not have evident endocrine deficiency. Baseline hormone profiles revealed normal T4, T3 and cortisol levels, 6 with elevated prolactin, 3 with reduced testosterone and 3 with slightly elevated basal TSH. The four menopausal women had impaired gonadotropin response to LHRH (100 micrograms, i.v.). Four (1 menstruating, 1 amenorrheic, 2 menopausal) women did not reach peak FSH response 4 hours after LHRH injection. The other amenorrheic woman had minimal FSH and LH response to LHRH which persisted even after 8 days of pulsatile infusion of LHRH (1 microgram/90min). TSH response to TRH (400 micrograms, i.v.) was delayed in 7 patients. GH response to human GRH (1 microgram/kg, i.v.) was impaired in 6 patients (maximal GH less than 5 mU/l). ACTH response to ovine CRH (1 microgram/kg, i.v.) was impaired in 3 patients (less than 50% elevation from baseline). Three patients who had normal GRH tests had impaired GH response to insulin hypoglycemia. Six patients had an empty sella on CT scan. From this study the following conclusions are drawn: (1) Among the four axes, GH is the most vulnerable. (2) The insulin tolerance test is still the best single test for evaluation of hypothalamic function.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. A probable case of Hand-Schueller-Christian's disease in an Egyptian mummy revealed by CT and MR investigation of a dry mummy.

    PubMed

    Cavka, Mislav; Petaros, Anja; Ivanac, Gordana; Aganović, Lejla; Janković, Ivor; Reiter, Gert; Speier, Peter; Nielles-Vallespin, Sonja; Brkljacić, Boris

    2012-03-01

    The challenging mission of paleopathologists is to be capable to diagnose a disease just on the basis of limited information gained by means of one or more paleodiagnostic techniques. In this study a radiologic, anthropologic and paleopathologic analysis of an ancient Egyptian mummy through X-rays, CT and MR was conducted. An Ancient Egyptian mummy ("Mistress of the house", Archeological Museum, Zagreb, Croatia) underwent digital radiography, computed tomography and magnetic resonance imaging employing 3-dimensional ultra-short-echo time (UTE) sequence, that allows to image ancient dry tissue. Morphological observations on the skull and pelvis, the stages of epiphyseal union and dental wear indicated that the remains are those of a young adult male. Multiple osseous lytic lesions were observed throughout the spine as well as on the frontal, parietal, and occipital bone, orbital wall and the sella turcica of the sphenoid. Considering the sex and age of the individual and the features of the lesions, the authors propose the diagnosis of Hand-Schueller-Christian's disease. This is the first study to have effectively used MR images in the differential diagnosis of a disease. It also confirmed the CT value in revealing central nervous system involvement just by detecting skeletal lesions. Although the mummy was previously dated to 3rd century B.C. based on the properties of the sarcophagi, the sex of the mummy suggests that it was most probably transferred into these sarcophagi in later times. The mummification techniques used and radiometric data (C14) dated it to 900-790. B.C.

  8. [Wooden models of human skeleton made in Edo era, Japan, with special reference to Hoshino wooden skeleton].

    PubMed

    Kataoka, Katsuko; Suzaki, Etsuko; Ajima, Noriaki

    2006-03-01

    The wooden model of the human skeleton, called wooden skeleton, is a distinguished original craft object in Edo era (1600-1867), Japan, when medical doctors were unable to keep the human skeleton for their study and teaching purpose. There are three kinds of wooden skeletons, i. e. Hoshino, Kagami and Okuda wooden skeletons made in 1792, 1810 and 1820, respectively. The former two are of adult male and the latter of female. They were made in surprising accuracy as compared with figures appeared in medical books available in Japan at that time, which suggests scientific readiness of the doctors and skills of the craftsmen. A complete set of the skeleton, except for the hyoid bone, has been preserved for Hoshino and Okuda wooden skeletons, while several bones have been missing in Kagami wooden skeleton. Each bone of Hoshino and Kagami wooden skeletons was made separately and connected by a tenon and a corresponding mortise at the articular surface. So it is hardly considered that all wooden bones were assembled into the whole body skeleton on use. Okuda wooden skeleton, on the other hand, was made for being shown in sitting position. The skull of Hoshino wooden skeleton is of special interest: the skull cap is not open, yet the internal structures of the skull, such as the sella turcica, foramina for nerves and vessels, and sulci for venous sinuses were made in considerable accuracy. Moreover, the proper connection of most foramina was proved between the inside and outside of the skull. The skull caps of Kagami and Okuda wooden skeletons are open as those used in the modern medical education.

  9. History of endonasal skull base surgery.

    PubMed

    Wang, Amy J; Zaidi, Hasan A; Laws, Edward D

    2016-12-01

    While the endonasal approach to the skull base continues to advance, this paper invokes its long history. The centuries of medieval neuroanatomy and early neurosurgery enabled the conception of the first transfacial approaches in the late 1800s; Henry Schloffer performed the first transsphenoidal surgery in 1907. Although the procedure was initially met with much interest, Harvey Cushing eventually led the field of neurosurgery to abandon the transsphenoidal approach in the 1920s. The following three generations of neurosurgeons contained several key figures including Norman Dott, Gerard Guiot, and Jules Hardy who were steadfast in preserving the technique as well as in addressing its shortcomings. The endoscopic approach developed simultaneously, and advances in magnifying and fiberoptics further resolved limitations previously inherent to the transsphenoidal approach. At last, in the 1960s, the transsphenoidal approach entered its renaissance. Today, the momentum of its development persists in the endoscopic endonasal approach, which has recently expanded the indications for transsphenoidal surgery across the skull base, far beyond its original jurisdiction of the sella. Continued progress must not take for granted the rich history of the transsphenoidal approach, which was developed over centuries by surgeons around the world. The authors present the evolution of modern endonasal surgery as a dynamic interplay between technology, medicine, and surgery over the past 100 years. Progress can be attributed to courageous surgeons who affirmed their contemporary practices despite gaps in technology or medicine, and to visionary individuals who produced and incorporated new elements into transsphenoidal surgery. And so while the new endoscopic technique brings forth new challenges, its development reaffirms the principles laid down by the pioneers of transsphenoidal surgery. PMID:27273318

  10. Norman Dott, Gerard Guiot, and Jules Hardy: key players in the resurrection and preservation of transsphenoidal surgery.

    PubMed

    Patel, Smruti K; Husain, Qasim; Eloy, Jean Anderson; Couldwell, William T; Liu, James K

    2012-08-01

    Developed over a century ago, the transsphenoidal approach to access lesions of the pituitary gland and sella turcica has transformed the field of neurosurgery, largely due to the work of Oskar Hirsch and Harvey Cushing. Furthermore, its use and modification in the early 1900s was perhaps one of Cushing's greatest legacies to skull base surgery. However, Cushing, who had worked relentlessly to improve the transsphenoidal route to the pituitary region, abandoned the approach by 1929 in his pursuit to master transcranial approaches to the suprasellar region. Hirsch and a few other surgeons continued to perform transsphenoidal operations, but they were unable to maintain the popularity of the approach among their peers. During a time when transsphenoidal surgery was on the brink of extinction, a critical lineage of 3 key surgeons--Norman Dott, Gerard Guiot, and Jules Hardy--would resurrect the art, each working to further improve the procedure. Dott, Cushing's apprentice from 1923 to 1924, brought his experiences with transsphenoidal surgery to Edinburgh, Scotland, and along the way, developed the lighted nasal speculum to provide better illumination in the narrow working area. Guiot, inspired by Dott, adopted his technique and used intraoperative radiofluoroscopic technique for image guidance. Hardy, a fellow of Guiot, from Montreal, Canada, revolutionized transsphenoidal microsurgery with the introduction of the binocular microscope and selective adenomectomy. The teachings of these pioneers have endured over time and are now widely used by neurosurgeons worldwide. In this paper, we review the lineage and contributions of Dott, Guiot, and Hardy who served as crucial players in the preservation of transsphenoidal surgery. PMID:22853837

  11. 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

  12. Cone beam computed tomographic analyses of alveolar bone anatomy at the maxillary anterior region in Chinese adults.

    PubMed

    Zhou, Zhixuan; Chen, Wu; Shen, Ming; Sun, Chao; Li, Jun; Chen, Ning

    2014-11-01

    To provide an anatomical basis for clinical implant esthetics, we evaluated the morphology of the nasopalatine canal (NPC) and analyzed labial and interproximal bone anatomy at the maxillary anterior region. We sought to investigate the effect of maxillary protrusion and tooth labiolingual inclination on labial bone anatomy in Chinese adults. Three dimensional (3D) images were reconstructed using cone-beam computed tomography (CBCT) images from 80 Chinese subjects and by SimPlant 11.04. The dimensions of the NPC, the thickness and profile of the labial bone, the width and height of the interproximal bone, angle sella-nasion-subspinale (SNA) and angle upper central incisor-nasion,subspinale (U1-NA) were measured. The incisive foramen of the NPC was markedly wider than its nasal foramen. The dimension of its labial bone wall demonstrated an increasing width from the crestal to apical measurements. The labial bone at the maxillary anterior region was rather thin, especially at 3 mm below the cemento-enamel junction (CEJ) and the mid-root level; the profile of the labial bone was more curved at the central incisor, and the interproximal bone became wider and shorter posteriorly. There were significant relationships between maxillary protrusion and labial bone profile, tooth labiolingual inclination and labial bone thickness (P < 0.02). To achieve optimal esthetic outcome of implant, bone augmentation is necessary at the maxillary anterior region. For immediate or early placement at the maxillary anterior region, the implant should be located palatally to reduce labial bone resorption and marginal recession; its apex should be angulated palatally to avoid labial perforation at the apical region. To protect the NPC, implants at the central incisor region should be placed away from NPC. PMID:25469120

  13. 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

  14. Factors influencing superimposition error of 3D cephalometric landmarks by plane orientation method using 4 reference points: 4 point superimposition error regression model.

    PubMed

    Hwang, Jae Joon; Kim, Kee-Deog; Park, Hyok; Park, Chang Seo; Jeong, Ho-Gul

    2014-01-01

    Superimposition has been used as a method to evaluate the changes of orthodontic or orthopedic treatment in the dental field. With the introduction of cone beam CT (CBCT), evaluating 3 dimensional changes after treatment became possible by superimposition. 4 point plane orientation is one of the simplest ways to achieve superimposition of 3 dimensional images. To find factors influencing superimposition error of cephalometric landmarks by 4 point plane orientation method and to evaluate the reproducibility of cephalometric landmarks for analyzing superimposition error, 20 patients were analyzed who had normal skeletal and occlusal relationship and took CBCT for diagnosis of temporomandibular disorder. The nasion, sella turcica, basion and midpoint between the left and the right most posterior point of the lesser wing of sphenoidal bone were used to define a three-dimensional (3D) anatomical reference co-ordinate system. Another 15 reference cephalometric points were also determined three times in the same image. Reorientation error of each landmark could be explained substantially (23%) by linear regression model, which consists of 3 factors describing position of each landmark towards reference axes and locating error. 4 point plane orientation system may produce an amount of reorientation error that may vary according to the perpendicular distance between the landmark and the x-axis; the reorientation error also increases as the locating error and shift of reference axes viewed from each landmark increases. Therefore, in order to reduce the reorientation error, accuracy of all landmarks including the reference points is important. Construction of the regression model using reference points of greater precision is required for the clinical application of this model. PMID:25372707

  15. Dissociated hypopituitarism after spontaneous pituitary apoplexy in acromegaly

    PubMed Central

    Mir, Shahnaz Ahmad; Masoodi, Shariq Rashid; Bashir, Mir Iftikhar; Wani, Arshad Iqbal; Farooqui, Khalid Jamal; Kanth, Basharat; Bhat, Abdul Rashid

    2013-01-01

    Introduction: Pituitary apoplexy is an uncommon event and usually occurs in non-functioning pituitary tumors. Among the functioning tumors, prolactinomas are the ones most likely to apoplexy. Apoplexy in growth hormone (GH) producing adenomas is a very rare event with less than thirty cases reported worldwide. Objective: To describe a case of spontaneous pituitary apoplexy in acromegaly. Case Report: A 55 year old smoker male presented to the our outpatient clinic in 2004 with complaints of gradual onset increase in the size of hands and feet, bilateral knee pain, increased sweating and blurring of vision. Investigations uncovered diabetes mellitus by a casual blood glucose of 243 mg/dl and HbA1c of 8.5%. Growth hormone suppression test using 75 gram oral glucose showed a 60 minute growth hormone of 105 ng/ml. Magnetic resonance imaging of the sellar region showed a 12.0 mm × 10.0 mm pituitary adenoma. The patient was planned for transsphenoidal tumor decompression. However, the patient was lost to follow up. Eight-years later, he presented in the emergency department of our institute with sudden onset headache, vomiting and decreased level of consciousness of one day duration. CT scan of the head with focus on the sella was suggestive of apoplexy which was later confirmed by the MRI of the sellar region. Conclusion: Although acromegaly can remit following apoplexy of the responsible pituitary adenoma, long term follow up is needed for early detection of the development of deficiency of pituitary hormones which may occur over years following the event as well as to detect tumor regrowth which again may occur several years later. PMID:24251123

  16. Familial acromegaly due to aryl hydrocarbon receptor-interacting protein (AIP) gene mutation in a Turkish cohort.

    PubMed

    Niyazoglu, Mutlu; Sayitoglu, Muge; Firtina, Sinem; Hatipoglu, Esra; Gazioglu, Nurperi; Kadioglu, Pinar

    2014-06-01

    Aryl hydrocarbon receptor-interacting protein (AIP) is associated with 15-20% of familial isolated pituitary adenomas and 50-80% of cases with AIP mutation exhibit a somatotropinoma. Herein we report clinical characteristics of a large family where AIP R304X variants have been identified. AIP mutation analysis was performed on a large (n = 52) Turkish family across six generations. Sella MRIs of 30 family members were obtained. Basal pituitary hormone levels were evaluated in 13 family members harboring an AIP mutation. Thirteen of 52 family members (25%) were found to have a heterozygous nonsense germline R304X mutation in the AIP gene. Seven of the 13 mutation carriers (53.8%) had current or previous history of pituitary adenoma. Of these 7 mutation carriers, all but one had somatotropinoma/somatolactotropinoma (85.7% of the pituitary adenomas). Of the 6 acromegaly patients with AIP mutation (F/M: 3/3) the mean age at diagnosis of acromegaly was 32 ± 10.3 years while the mean age of symptom onset was 24.8 ± 9.9 years. Three of the six (50%) acromegaly cases with AIP mutation within the family presented with a macroadenoma and none presented with gigantism. Biochemical disease control was achieved in 66.6% (4/6) of the mutation carriers with acromegaly after a mean follow-up period of 18.6 ± 17.6 years. Common phenotypic characteristics of familial pituitary adenoma or somatotropinoma due to AIP mutation vary between families or even between individuals within a family. PMID:23743763

  17. Lycopene and Beta-Carotene Induce Growth Inhibition and Proapoptotic Effects on ACTH-Secreting Pituitary Adenoma Cells

    PubMed Central

    Leite de Oliveira, Felipe; Soares, Nathália; de Mattos, Rômulo Medina; Hecht, Fábio; Dezonne, Rômulo Sperduto; Vairo, Leandro; Goldenberg, Regina Coeli dos Santos; Gomes, Flávia Carvalho Alcântara; de Carvalho, Denise Pires; Gadelha, Mônica R.; Nasciutti, Luiz Eurico; Miranda-Alves, Leandro

    2013-01-01

    Pituitary adenomas comprise approximately 10–15% of intracranial tumors and result in morbidity associated with altered hormonal patterns, therapy and compression of adjacent sella turcica structures. The use of functional foods containing carotenoids contributes to reduce the risk of chronic diseases such as cancer and vascular disorders. In this study, we evaluated the influence of different concentrations of beta-carotene and lycopene on cell viability, colony formation, cell cycle, apoptosis, hormone secretion, intercellular communication and expression of connexin 43, Skp2 and p27kip1 in ACTH-secreting pituitary adenoma cells, the AtT20 cells, incubated for 48 and 96 h with these carotenoids. We observed a decrease in cell viability caused by the lycopene and beta-carotene treatments; in these conditions, the clonogenic ability of the cells was also significantly decreased. Cell cycle analysis revealed that beta-carotene induced an increase of the cells in S and G2/M phases; furthermore, lycopene increased the proportion of these cells in G0/G1 while decreasing the S and G2/M phases. Also, carotenoids induced apoptosis after 96 h. Lycopene and beta-carotene decreased the secretion of ACTH in AtT20 cells in a dose-dependent manner. Carotenoids blocked the gap junction intercellular communication. In addition, the treatments increased the expression of phosphorylated connexin43. Finally, we also demonstrate decreased expression of S-phase kinase-associated protein 2 (Skp2) and increased expression of p27kip1 in carotenoid-treated cells. These results show that lycopene and beta-carotene were able to negatively modulate events related to the malignant phenotype of AtT-20 cells, through a mechanism that could involve changes in the expression of connexin 43, Skp2 and p27kip1; and suggest that these compounds might provide a novel pharmacological approach to the treatment of Cushing’s disease. PMID:23667519

  18. Is Baja California part of the Pacific Plate?

    NASA Astrophysics Data System (ADS)

    Plattner, C.; Malservisi, R.; Dixon, T. H.; Lafemina, P. C.; Schmalzle, G.; Fletcher, J.; Suarez-Vidal, F.

    2005-12-01

    Coupling GPS observations with numerical modeling we can answer this important question and evaluate the effect of a non-complete coupling on the kinematics of the Western hemisphere. Until 12 Ma the western coast of Baja California (BC) was the location of the subduction of the Pacific plate (PA) underneath the North American plate (NA). It is a common assumption that the eastward migration of the plate boundary was complete ~3.6Ma and that since that time the Gulf of California has accommodate the full relative motion between North America and Pacific. One of the main consequences of this assumption is that the magnetic anomalies in the Gulf of California allow estimating the average relative motion between NA and PA. On the other hand, published geodetic measurement (e.g. Sella et al, 2000) indicate that NA is moving respect to PA at an higher rate then estimated by the spreading rate (DeMets et al 1994) and the few published GPS measurements in the Baja California Peninsula (Dixon and DeMets 1999, Dixon et al 2000, Dixon et al. 2001, Beaven et al. 2002, Gonzalez-Garcia et al. 2003) indicate that the velocity of the sites with respect to a rigid Pacific plate have significant residuals. These observations suggest that the Peninsula is not completely coupled with the Pacific plate and the Gulf of California spreading does not fully represent the NA/PA motion. Here we suggest using the extensive network of campaign GPS of CICESE/University of Miami combined with the Southern California Earthquake Center (SCEC) for the Mexico/US border region, to quantify the missing motion and how it is accommodate. In particular, we will use the GPS and numerical models to verify if BC behaves as a rigid block as the absence of intra-peninsular faults seems to indicate (in this case the missing motion must be searched west of BC).

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

    PubMed Central

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

    2015-01-01

    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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. Clinical features and differential diagnosis of pituitary tumours with emphasis on acromegaly.

    PubMed

    Hennessey, J V; Jackson, I M

    1995-04-01

    Pituitary adenomas are frequently encountered, benign intracranial tumours. Clinically classified according to their capacity to produce and secrete hormones, pituitary tumours are diagnosed from the clinical manifestations and biochemical findings of specific pituitary hormone overproduction or of impaired pituitary function due to pressure on normal pituitary cells, the pituitary stalk or the hypothalamus. Additionally, the tumour may result in neurological manifestations due to its effect as an intracranial space-occupying lesion. Pituitary adenomas may present acutely with pituitary apoplexy after intrapituitary haemorrhage or infarction. The subsequent hypofunction of the pituitary with concomitant neurological sequelae of an expanding intracranial mass are often associated with excruciating headache, diplopia and visual field defects. Gradually developing neurological deficits or secondary endocrine failure over several years may precede the recognition of non-secretory tumours (30-40% of pituitary adenomas) as well as some of the hormone-producing adenomas, especially when they expand beyond the confines of the sella turcica. Asymptomatic masses occur in the pituitary in 5-27% of unselected autopsy series. About 10-20% of pituitaries imaged as part of a brain study contain lesions 'consistent with a pituitary adenoma', with about half being pituitary adenomas ('incidentalomas'). Many advocate screening such cases for a wide spectrum of pituitary function abnormalities. Clinical judgement should be utilized to determine the extent of the work-up and the frequency of follow-up. Acromegaly, a clinical syndrome caused by excess growth hormone secretion, accounts for one-sixth of resected pituitary tumours. This disorder leads to chronic progressive disability and a shortened life span, with approximately 50% of untreated acromegalic patients experiencing premature death. The prevalence of acromegaly has been estimated to range from 50 to 70 per million, with the

  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. 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

  8. Predictability and Reliability of Different Anterio-Posterior Skeletal Discrepancy Indicators in Different Age Groups - A Cephalometric Study

    PubMed Central

    Tiwari, Rana; Gupta, Abhishek; Joshi, Rishi; Tiwari, Anil; Sen, Priyank

    2016-01-01

    Introduction The lateral cephalometric skeletal discrepancy indicators play a major role in diagnosing and preparing a case for orthognathic surgeries and the dentofacial corrections. Aim The study was aimed to check the reliability and the predictability of different anterio-posterior skeletal discrepancy indicators in different age groups and to derive the most reliable indicator for the orthodontic diagnosis. Materials and Methods A cross-sectional study was conducted on a sample of 100 subjects including 29 adolescent (15 males and 14 females) and 71 adult (41 males and 30 females) subjects with the mean age of 19.05 ± 5.78 years. All the subjects had Angle’s Class I molar relationship. The lateral cephalograms of the sample were taken under the standard setting and hand tracing of the cephalometric radiographs using a sharp 4H pencil were made on acetate tracing paper. The anterio-posterior cephalometric indicators like β-angle, Wits appraisal (mm), Sella- Nasion plane to Point A and Point B distance (SN-AB mm) and Maxillo-Mandibular plane angle bisector to Point A and Point B distance (MM-AB mm) were measured. Intra-examiner reliability of tracings was evaluated using Intra Class Correlation (ICC) test. Mann Whitney U-test was applied for comparison of parameters between different malocclusion groups. Concurrent validity of various parameters was calculated using Cohen’s kappa. A p-value <0.05 was considered statistically significant. Results The comparison of intra-examiner reliability of tracings in Angle’s Class I adolescent group showed, MM-AB to have an almost perfect agreement followed by Wits. Intra-examiner reliability of tracings in Angle’s Class I adult group showed moderate agreement for Wits and MM-AB showed almost perfect agreement and all the parameters showed statistically significant ICC. Comparison of parameters between adolescent and adult, Angle’s Class I malocclusion group showed significant difference between adolescent and

  9. Clinical features and differential diagnosis of pituitary tumours with emphasis on acromegaly.

    PubMed

    Hennessey, J V; Jackson, I M

    1995-04-01

    Pituitary adenomas are frequently encountered, benign intracranial tumours. Clinically classified according to their capacity to produce and secrete hormones, pituitary tumours are diagnosed from the clinical manifestations and biochemical findings of specific pituitary hormone overproduction or of impaired pituitary function due to pressure on normal pituitary cells, the pituitary stalk or the hypothalamus. Additionally, the tumour may result in neurological manifestations due to its effect as an intracranial space-occupying lesion. Pituitary adenomas may present acutely with pituitary apoplexy after intrapituitary haemorrhage or infarction. The subsequent hypofunction of the pituitary with concomitant neurological sequelae of an expanding intracranial mass are often associated with excruciating headache, diplopia and visual field defects. Gradually developing neurological deficits or secondary endocrine failure over several years may precede the recognition of non-secretory tumours (30-40% of pituitary adenomas) as well as some of the hormone-producing adenomas, especially when they expand beyond the confines of the sella turcica. Asymptomatic masses occur in the pituitary in 5-27% of unselected autopsy series. About 10-20% of pituitaries imaged as part of a brain study contain lesions 'consistent with a pituitary adenoma', with about half being pituitary adenomas ('incidentalomas'). Many advocate screening such cases for a wide spectrum of pituitary function abnormalities. Clinical judgement should be utilized to determine the extent of the work-up and the frequency of follow-up. Acromegaly, a clinical syndrome caused by excess growth hormone secretion, accounts for one-sixth of resected pituitary tumours. This disorder leads to chronic progressive disability and a shortened life span, with approximately 50% of untreated acromegalic patients experiencing premature death. The prevalence of acromegaly has been estimated to range from 50 to 70 per million, with the

  10. Radiation therapy of acromegaly.

    PubMed

    Eastman, R C; Gorden, P; Glatstein, E; Roth, J

    1992-09-01

    Conventional megavoltage irradiation of GH-secreting tumors has predictable effects on tumor mass, GH, and pituitary function. 1. Further growth of the tumor is prevented in more than 99% of patients, with only a fraction of a percent of patients requiring subsequent surgery for tumor mass effects. 2. GH falls predictably with time. By 2 years GH falls by about 50% from the baseline level, and by 5 years by about 75% from the baseline level. The initial GH elevation and the size and erosive features of the sella turcica do not affect the percent decrease in GH from the baseline elevation. 3. With prolonged follow-up, further decrease in GH is seen at 10 and 15 years, with the fraction of surviving patients achieving GH levels less than 5 ng/mL approaching 90% after 15 years in our experience. Gender, previous surgery, and hyperprolactinemia do not seem to affect the response to treatment. Patients with initial GH greater than 100 ng/mL are significantly less likely to achieve GH values less than 5 ng/mL during long-term follow-up. 4. Hypopituitarism is a predictable outcome of treatment, is delayed, and may be more likely in patients who have had surgery prior to irradiation. There is no evidence that this complication is more common in patients with acromegaly than in patients with other pituitary adenomas receiving similar treatment. 5. Vision loss due to megavoltage irradiation--using modern techniques and limiting the total dose to 4680 rad given in 25 fractions over 35 days, with individual fractions not exceeding 180 rad--is extremely rare. The reported cases have occurred almost entirely in patients who have received larger doses or higher fractional doses. The theory that patients with acromegaly are prone to radiation-induced injury to the CNS and optic nerves and chiasm because of small vessel disease is not supported by a review of the reported cases. 6. Brain necrosis and secondary neoplasms induced by irradiation are extremely rare. 7. Although

  11. 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

  12. Genetically induced abnormal cranial development in human trisomy 18 with holoprosencephaly: comparisons with the normal tempo of osteogenic-neural development.

    PubMed

    Reid, Shaina N; Ziermann, Janine M; Gondré-Lewis, Marjorie C

    2015-07-01

    Craniofacial malformations are common congenital defects caused by failed midline inductive signals. These midline defects are associated with exposure of the fetus to exogenous teratogens and with inborn genetic errors such as those found in Down, Patau, Edwards' and Smith-Lemli-Opitz syndromes. Yet, there are no studies that analyze contributions of synchronous neurocranial and neural development in these disorders. Here we present the first in-depth analysis of malformations of the basicranium of a holoprosencephalic (HPE) trisomy 18 (T18; Edwards' syndrome) fetus with synophthalmic cyclopia and alobar HPE. With a combination of traditional gross dissection and state-of-the-art computed tomography, we demonstrate the deleterious effects of T18 caused by a translocation at 18p11.31. Bony features included a single developmentally unseparated frontal bone, and complete dual absence of the anterior cranial fossa and ethmoid bone. From a superior view with the calvarium plates removed, there was direct visual access to the orbital foramen and hard palate. Both the eyes and the pituitary gland, normally protected by bony structures, were exposed in the cranial cavity and in direct contact with the brain. The middle cranial fossa was shifted anteriorly, and foramina were either missing or displaced to an abnormal location due to the absence or misplacement of its respective cranial nerve (CN). When CN development was conserved in its induction and placement, the respective foramen developed in its normal location albeit with abnormal gross anatomical features, as seen in the facial nerve (CNVII) and the internal acoustic meatus. More anteriorly localized CNs and their foramina were absent or heavily disrupted compared with posterior ones. The severe malformations exhibited in the cranial fossae, orbital region, pituitary gland and sella turcica highlight the crucial involvement of transcription factors such as TGIF, which is located on chromosome 18 and contributes

  13. 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

  14. [A case of pituitary adenoma progressing to pituitary apoplexy on the occasion of cerebral angiography].

    PubMed

    Suga, T; Kagawa, S; Goto, H; Yoshioka, K; Hosoya, T

    1996-05-01

    A case of pituitary adenoma which had progressed from subclinical pituitary apoplexy to subacute pituitary apoplexy on the occasion of cerebral angiography is reported. A 29-year-old man, complaining of bitemporal hemianopsia, was admitted to our department. Plain skull X-p revealed enlargement and double floor of the sella turcica. No abnormal calcification was revealed. CT demonstrated an isodensity mass with a diameter of 4 x 4 cm, and with ring enhancement in the suprasellar region. The mass extended from the intrasellar region to the suprasellar region and had a signal of high intensity on T1-weighted images. Endocrinological examination revealed hyperprolactinemia with a serum level of 422 ng/ml and normal reaction of anterior pituitary hormones. On 3rd March, digital subtraction angiography with 5F catheter was performed with the patient under sedation. The contrast medium was ioxaglic acid (Hexabrix 320). A volume of 6 ml with a speed of 4 ml per second was injected for the internal carotid angiogram. A total volume of 60 ml was used. Serum saline with 10 unit per ml of heparin sodium was also used for flushing. During angiography, the patient's blood pressure was 125/60-115/60mm Hg. DSA revealed upward displacement of the proximal portion of the anterior cerebral artery, pocket formation, and staining of the tumor capsule. Six hours later, he complained of retroorbital headache. Next morning, he noticed complete lack of left visual acuity. On 7th March, right visual acuity degenerated to blindness. CT revealed that the mass had increased its density. With bifrontal osteoplastic craniotomy, the tumor with marked intratumoral hemorrhage was resected. Its histology was chromophobe adenoma. The patient's right visual acuity improved rapidly. On the occasion of cerebral angiography, we could observe that subclinical pituitary apoplexy deteriorated to subacute pituitary apoplexy. Rosenbaum postulated that injection of contrast media increased intravascular

  15. 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

  16. 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.

  17. Acromegaly.

    PubMed

    Scacchi, Massimo; Cavagnini, Francesco

    2006-01-01

    Acromegaly is a slowly progressive disease characterized by 30% increase of mortality rate for cardiovascular disease, respiratory complications and malignancies. The estimated prevalence of the disease is 40 cases/1000000 population with 3-4 new cases/1000000 population per year. The biochemical diagnosis is based upon the demonstration of high circulating levels of GH and IGF-I. A random GH level lower than 0.4 microg/l and an IGF-I value in the age- and sex-matched normal range makes the diagnosis of acromegaly unlikely. In doubtful cases, the lack of GH suppressibility below 1 microg/l (0.3 microg/l according to recent reports) after an oral glucose load will confirm the diagnosis. A pituitary adenoma is demonstrated in most cases by CT scan or MRI. A negative X-ray finding or the presence of empty sella do not exclude the diagnosis. Cardiovascular complications (acromegalic cardiomyopathy and arterial hypertension) should be looked for and, if present, followed-up by echocardiography and 24h-electrocardiogram. Sleep apnoea, when clinically suspicious, should be confirmed by polisomnography. At the moment of diagnosis all patients should undergo colonscopy. Lipid profile should be obtained and glucose tolerance evaluated. Surgery, radiotherapy and medical treatment represent the therapeutic options for acromegaly. The outcome of transsphenoidal surgery is far better for microadenomas (80-90%) than for macroadenomas (less than 50%), which unluckily represent more than 70% of all GH-secreting pituitary tumours. Therefore, pituitary surgery is the first line treatment for microadenomas. Medical therapy is based on GH-lowering drugs (somatostatin receptor agonists and, in some cases, dopaminergic agents) and GH receptor antagonists (pegvisomant). The former are traditionally indicated after unsuccessful surgery and while awaiting the effectiveness of radiation therapy. However, GH-lowering drugs are also used as primary therapy when surgery is contraindicated or in

  18. 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

  19. Geophysical modelling of subsidence on the Mississippi Delta

    NASA Astrophysics Data System (ADS)

    Wolstencroft, Martin; Shen, Zhixiong; Törnqvist, Torbjorn; Milne, Glenn; Kulp, Mark

    2014-05-01

    The Mississippi Delta (MD) is experiencing relative sea level rise of approximately 10 mm/yr (Penland and Ramsey, 1990). This rate is caused by a combination of global sea level rise and local subsidence of the land surface. The relative importance of processes thought to be responsible for this subsidence is vigorously debated. Many previous studies have postulated that isostatic subsidence of the Pleistocene basement caused by sediment loading of the MD itself is the major contributor. GPS surveys have produced subsidence rates greater than 5 mm/yr in the MD (e.g. Dokka et al. 2006). Computational modeling studies of vertical land motion on decadal timescales have reproduced these high rates, but required extreme and arguably unrealistic parameter values to do so. Additionally, subsidence rates in the MD on thousand year timescales due to delta loading are found to be an order of magnitude lower than GPS rates (e.g. Törnqvist et al., 2006; Yu et al., 2012). In an attempt to understand the source of this disagreement between data types and better understand the uncertainties in the modelling process, we carried out a sensitivity analysis using a spherically symmetric visco-elastic deformation model. The model included sediment, ice, and ocean load histories from the last 80 kyr. The model results were compared with observations of vertical land motion over three different time scales (past 80 kyr, past 7 kyr, past ~15 years). We found that glacial isostatic adjustment is likely to be the dominant contributor to present-day deformation of the Pleistocene and underlying basement. Basement subsidence rates solely due to sediment loading were found to be less than 0.5 mm/yr. In general, sedimentary processes such as compaction of the Holocene strata appear to contribute more to land surface lowering than subsidence of the basement rock. REFERENCES Dokka, R. K., G. F. Sella, and T. H. Dixon (2006), Tectonic control of subsidence and southward displacement of southeast

  20. 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

  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. [Approach to the jugular foramen and related structures - an analysis of the surgical technique based on cadaver simulation].

    PubMed

    Ladziński, Piotr; Maliszewski, Mariusz; Kaspera, Wojciech; Szczygieł, Majchrzak; Tymowski, Michał

    2011-01-01

    This study presents consecutive stages of the approach to the jugular foramen and related structures. Eleven simulations of the approach were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schematic diagrams. The starting point for the discussed approach is removal of the mastoid and petrosal parts of the temporal bone, as well as the jugular process and the jugular tuberculum. It allows penetration of the jugular foramen from the back. Widening of the approach enables penetration of the jugular foramen from above and the front. Approach to the jugular foramen is a reproducible technique, which provides surgical penetration of this foramen and related structures. This approach is particularly useful in the surgical treatment of tumours expanding in the petrous pyramid, surroundings of the petrosal part of the internal carotid artery, cerebellopontine angle, subtemporal fossa and nervous-vascular bundle of the neck. PMID:21866483

  4. 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.

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

    PubMed Central

    Geng, Fan‐Suo; Manning, Elizabeth; Suster, Maximiliano; Kawakami, Koichi; Becker, Thomas S.

    2015-01-01

    Summary 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. genesis 53:640–651, 2015. © 2015 The Authors. genesis Published by Wiley Periodicals, Inc. PMID:26271004

  6. 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

  7. One-piece modified gasket seal technique.

    PubMed

    Wessell, Aaron; Singh, Ameet; Litvack, Zachary

    2013-10-01

    Objectives Review the effectiveness of a modified gasket seal technique utilizing a porous high-density polyethylene plate/rectus sheath fascia construct without fat grafting for primary closure of anterior defects following endoscopic skull base surgery. Design Retrospective review (2011-2012). Setting Single academic medical center. Methods A retrospective review of five patients who underwent expanded endoscopic endonasal surgery for various pathologies (two craniopharyngiomas, two tuberculum meningiomas, and one planum meningioma) was performed. Skull base closure was performed using a one-piece modified gasket seal technique. Primary outcome measures included postoperative cerebrospinal fluid (CSF) leaks and donor site morbidity. Results There were no postoperative CSF leaks. Two patients experienced aseptic meningitis treated with a 14-day course of steroids. Two patients experienced new postoperative chronic/recurrent sinusitis treated with oral antibiotics and topical nasal therapy. There was no donor site morbidity such as infection, hematoma, or hernias. Conclusions The one-piece modified gasket-seal closure is a safe and effective method for reconstruction of endonasal defects of the anterior skull base. Rectus sheath fascia is an appropriate dural substitute for free tissue grafting with low donor site morbidity. The construction of the one-piece graft significantly decreases operative time and lowers the learning curve for multilayered closure.

  8. 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

  9. 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

  10. 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

  11. 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.

  12. Distribution pattern of neuropeptide Y in the brain, pituitary and olfactory system during the larval development of the toad Rhinella arenarum (Amphibia: Anura).

    PubMed

    Heer, T; Pozzi, A G; Yovanovich, C A; Paz, D A

    2009-04-01

    The first NPY-immunoreactivity (ir) in the central nervous system of Rhinella arenarum was obtained just after hatching in the pre-optic area, ventral thalamus and rostral rhombencephalon. During pre-metamorphosis, new NPY-ir cells were observed in other brain areas such as pallium, septum and striatum, infundibulum and pars intermedia of the pituitary. Further maturation continued through pro-metamorphosis with the appearance of cell groups in the diagonal band, amygdala, pre-optic nucleus, dorsal nucleus of the habenula, anterior ventral and dorsal thalamus, suprachiasmatic nucleus, tuberculum posterior, tectum, torus semicircularis, inter-peduncular nucleus and median eminence. During the metamorphic climax and soon after, the relative abundance of NPY-ir fibres decreased in all hypothalamic areas and the staining intensity and number of NPY-ir cells in the pallium also decreased, whereas no cells were found in the striatum, dorsal nucleus of the habenula and tectum. In the olfactory epithelium, nerve or bulb, neither cells nor NPY-ir fibres were found during the stages of development analysed. The ontogeny pattern of the NPY-ir neuronal system in the brain of Rh. arenarum is more similar to the spatiotemporal appearance reported for Rana esculenta than to that reported for Xenopus laevis. Many NPY-ir fibres were found in the median eminence and in the pars intermedia of the pituitary, supporting the idea that this neuropeptide may play a role in the modulation of hypophyseal secretion during development.

  13. 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

  14. Mathematical study on the guidance of the tibiofemoral joint as theoretical background for total knee replacements.

    PubMed

    Fiedler, Christoph; Gezzi, Riccardo; Frosch, Karl-Heinz; Wachowski, Martin Michael; Kubein-Meesenburg, Dietmar; Dörner, Jochen; Fanghänel, Jochen; Nägerl, Hans

    2011-01-01

    The mathematical approach presented allows main features of kinematics and force transfer in the loaded natural tibiofemoral joint (TFJ) or in loaded knee endoprostheses with asymmetric condyles to be deduced from the spatial curvature morphology of the articulating surfaces. The mathematical considerations provide the theoretical background for the development of total knee replacements (TKR) which closely reproduce biomechanical features of the natural TFJ. The model demonstrates that in flexion/extension such kinematic features as centrodes or slip ratios can be implemented in distinct curvature designs of the contact trajectories in such a way that they conform to the kinematics of the natural TFJ in close approximation. Especially the natural roll back in the stance phase during gait can be reproduced. Any external compressive force system, applied to the TFJ or the TKR, produces two joint reaction forces which--when applying screw theory--represent a force wrench. It consists of a force featuring a distinct spatial location of its line and a torque parallel to it. The dependence of the geometrical configuration of the force wrench on flexion angle, lateral/medial distribution of the joint forces, and design of the slopes of the tuberculum intercondylare is calculated. The mathematical considerations give strong hints about TKR design and show how main biomechanical features of the natural TFJ can be reproduced.

  15. 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.

  16. Circadian modulation of dopamine levels and dopaminergic neuron development contributes to attention deficiency and hyperactive behavior.

    PubMed

    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; Wang, Han

    2015-02-11

    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.

  17. 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.

  18. 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

  19. 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.

  20. Tinea atypica: report of nine cases.

    PubMed

    Zisova, Liliya Georgieva; Dobrev, Hristo Petrov; Tchernev, Georgi; Semkova, Kristina; Aliman, Anastasia Atanasova; Chorleva, Kristina Ivanova; Chapanova, Antonina Teneva; Vutova, Nina Ivanova; Wollina, Uwe

    2013-12-01

    Fungal infections of the skin are a common condition, usually easy to diagnose and treat. When the infection is clinically mimicking another cutaneous disorder or when the clinical presentation is modified by the use of inappropriate treatment, it is referred to as tinea atypica or tinea incognito.We report a series of nine cases of patients with tinea atypica, imitating and diagnosed initially as different skin diseases. Two patients were defined as pyoderma in the facial and pubic regions (caused respectively by Trichophyton mentagrophytes var. mentagrophytes and Microsporum canis) and one as herpes zoster ophthalmicus (caused by Trichophyton rubrum). Six additional patients were initially misdiagnosed: (1) Plaque-like formation of the skin misdiagnosed as an impetiginized eczema (with isolated agent Trichophyton verrucosum). (2) A rare form of skin infection of the hand caused by T. rubrum, imitating clinically cutaneous infection with tuberculum mulgentium. (3) Rosacea-like dermatitis with an isolated agent Fusarium. (4) A patient with the typical clinical symptoms of seborrheic dermatitis of the face (and with isolated T. rubrum as a causative agent). (5) Another patient presented with a widespread folliculitis by Trichophyton mentagrophytes. (6) In a patient with bullous pemphigoid and immunosuppression pemphigoid-like eruptions were caused by Malassezia pachydermatis and T. rubrum. The diagnosis in the presented cases was based on direct microscopic examination with KOH and a culture on Sabouraud agar.After the diagnosis of tinea, treatment with topical and systemic antifungal agents was administrated, followed by complete clinical remissions in all cases.The clinical manifestations of tinea atypica can mimic a large number of other dermatoses, which often leads to misdiagnosing, and as a consequence--to serious difficulties in the management of clinical symptoms and in offering appropriate therapy.

  1. 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

  2. Retinal projections in the freshwater butterfly fish, Pantodon buchholzi (Osteoglossoidei). I. Cytoarchitectonic analysis and primary visual pathways.

    PubMed

    Butler, A B; Saidel, W M

    1991-01-01

    The freshwater butterfly fish, Pantodon buchholzi, is a member of the most primitive radiation of teleosts. The retinofugal projections were studied in this fish with autoradiographic and horseradish peroxidase (HRP) methods, and the cytoarchitecture of the retinorecipient regions in the diencephalon and pretectum was analyzed with Bodian-, cresylecht-violet- and acetylcholinesterase-reacted sections. The rostral diencephalon of Pantodon contains a large retinorecipient nucleus, not previously identified in any other fish, i.e. nucleus rostrolateralis. Other nuclei that are described correspond to those previously recognized in other species. The majority of retinorecipient nuclei are positive for acetylcholinesterase, particularly those in the pretectum, as has been found in other species of teleosts. Most of the retinofugal fibers decussate in the optic chiasm. Some fibers project via the axial optic tract to preoptic nuclei and a region in the rostral hypothalamus. Fibers leave the medial optic tract to terminate in nucleus rostrolateralis and in dorsal and ventral thalamic nuclei, accessory optic and tubercular nuclei, periventricular and central pretectal nuclei, and sparsely in the deep tectal fascicle and terminal field. Dorsal optic tract fibers project to the dorsal accessory optic nucleus, superficial and central pretectal nuclei, and superficial and deep tectal layers. Ventral optic tract fibers project to the superficial pretectum, accessory optic nuclei, posterior tuberculum, nucleus corticalis in the central pretectum, and superficial tectal layer. Fibers that remain in the ipsilateral optic tract project to most of the targets reached by contralaterally projecting fibers. A few fibers in the contralateral medial optic tract redecussate via the posterior commissure to reach the ipsilateral periventricular pretectum. No labeled retinopetal cells caudal to the olfactory bulb were identified in any of the HRP cases.

  3. Developmental expression of three forms of gonadotropin-releasing hormone and ontogeny of the hypothalamic-pituitary-gonadal axis in gilthead seabream (Sparus aurata).

    PubMed

    Wong, Ten-Tsao; Gothilf, Yoav; Zmora, Nilli; Kight, Katherine E; Meiri, Iris; Elizur, Abigail; Zohar, Yonathan

    2004-09-01

    To address the complexity of the origin of the GnRH system in perciforms, we investigated the ontogenic expression of three GnRHs in gilthead seabream. Using in situ hybridization, chicken (c) GnRH-II mRNA-expressing cells were detected in the hindbrain at 1.5 days postfertilization (DPF) and in the midbrain at 2 DPF and thereafter; the hindbrain signals became undetectable after 10 DPF. Salmon (s) GnRH mRNA-expressing cells were first seen in the olfactory placode at 3 DPF, started caudal migration at 14 DPF, and reached the preoptic areas at 59 DPF. Seabream (sb) GnRH mRNA-expressing cells were first detected in the terminal nerve ganglion cells (TNgc), ventral part of the ventral telencephalon, nucleus preopticus parvocellularis, and thalamus at 39 DPF, and extended to the nucleus preopticus magnocellularis at 43 DPF, ventrolateral hypothalamus at 51 DPF, and nucleus lateralis tuberis and posterior tuberculum at 59 DPF. Coexpression of sbGnRH and sGnRH transcripts was found in the TNgc. Using real-time fluorescence-based quantitative polymerase chain reaction, transcript levels of cGnRH-II and sGnRH were first detected at 1 and 1.5 DPF, respectively, and increased and remained high thereafter. Transcript levels of sbGnRH remained low after first detection at 1 DPF. Furthermore, these GnRH expression profiles were correlated with the expression profiles of reproduction-related genes in which at least four concomitant increases of GnRH, GnRH receptor, gonadotropin, gonadotropin receptor, and Vasa transcripts were found at 5, 8, 14, and 28 DPF. Our data provide an expanded view of the ontogeny of the GnRH system and reproductive axis in perciforms.

  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. Endoscopic endonasal trans-sphenoid management of craniopharyngiomas

    PubMed Central

    Yadav, Yad Ram; Nishtha, Yadav; Vijay, Parihar; Shailendra, Ratre; Yatin, Kher

    2015-01-01

    Introduction: Craniopharyngiomas treatment has been challenging because of their anatomical location. The endoscopic endonasal (EE) trans-sphenoidal approach is indicated in sellar, supra sellar, selected intraventricular lesions in adults and children. We are reporting our initial experience of 44 patients managed by EE approach. Materials and Methods: This is a retrospective study of 44 craniopharyngiomas. The goal of surgery was gross-total resection in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Lumbar drain at the start of the operation was used in all cases with tumor larger than 3 cm maximum diameter. Binostril technique vascularized nasoseptal flap and multilayer closure of the dural defect were used. Wide sphenoidotomy, posterior ethmoidectomy, tuberculum selle, and planum removal were performed in all cases. Perioperative antibiotic prophylaxis was used for 72 h. Results: There were 44 patients of age ranging from 8 to 65 (mean: 42) years. Diameter of the tumor varied from 3.1 cm to 6.6 cm (average: 4.3 cm). Visual and pituitary dysfunctions were observed in 44 and 33, respectively, before surgery. Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively. Average follow-up was 19 months. Conclusion: Endoscopic endonasal trans-sphenoidal approach for craniopharyngioma is safe and effective alternative to transcranial approach in selected patients. Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge. PMID:25767569

  7. 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

  8. Steroid-induced changes in the morphology of GnRH neurons in the male leopard frog, Rana pipiens: correlation with plasma gonadotropin and gonadal size.

    PubMed

    Tsai, Pei-San; Jones, Jeremy T

    2005-04-01

    Previously, we reported that hypothalamic explants isolated from male leopard frogs (Rana pipiens) implanted with 17beta-estradiol (E2), but not 5alpha-dihydrotestosterone (DHT), released significantly higher levels of gonadotropin-releasing hormone (GnRH) in response to a veratridine challenge. In this study, we measured changes in GnRH soma size, circulating luteinizing hormone (LH), and gonadosomatic index (GSI) in response to these two steroid hormones to further assess the impact of these hormones on the hypothalamic-pituitary-gonadal axis. Sexually mature male R. pipiens were implanted with silastic capsules containing cholesterol (Ch; control), E2, or DHT for 20 days. GnRH immunocytochemistry (ICC) revealed that both E2 and DHT significantly enlarged GnRH soma size without affecting the total number of GnRH neurons in the forebrain. The effects of E2 and DHT were specific, since neither hormone altered the soma size of tyrosine hydroxylase neurons in the dorsomedial posterior tuberculum. Circulating LH levels were significantly reduced in animals treated with both steroid hormones, with E2 exerting the most potent inhibitory effect. A significant inverse correlation was observed between the GSI and GnRH soma size in Ch controls, suggesting animals with larger GnRH neurons tended to have smaller gonads. Overall, our results showed that both steroid hormones induced the accumulation of GnRH and ultimately the swelling of the GnRH soma. Further, larger GnRH neurons were associated with smaller gonads and lower circulating levels of LH, suggesting a link between enlarged GnRH neurons and an overall decrease in the reproductive activity of R. pipiens.

  9. 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

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

    PubMed

    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

  11. Evolution of the vertebrate pth2 (tip39) gene family and the regulation of PTH type-2 Receptor (pth2r) and its endogenous ligand pth2 by Hedgehog signaling in zebrafish development

    PubMed Central

    Bhattacharya, Poulomi; Yan, Yi Lin; Postlethwait, John; Rubin, David A.

    2011-01-01

    In mammals, parathyroid hormone (PTH), secreted by parathyroid glands, increases calcium levels in the blood from reservoirs in bone. While mammals have two PTH receptor genes, PTH1R and PTH2R, zebrafish has three, pth1r, pth2r and pth3r. PTH can activate all three zebrafish Pthrs while PTH2 (alias tuberoinfundibular peptide 39, TIP39) preferentially activates zebrafish and mammalian PTH2Rs. We know little about the roles of the PTH2/PTH2R system in the development of any animal. To determine the roles of PTH2 and PTH2R during vertebrate development, we evaluated their expression patterns in developing zebrafish, observed their phylogenetic and conserved synteny relationships with humans, and described the genomic organization of pth2, pth2r, and pth2r splice variants. Expression studies showed that pth2 is expressed in cells adjacent to the ventral part of the posterior tuberculum in the diencephalon, whereas pth2r is robustly expressed throughout the CNS. Otic vesicles express both pth2 and pth2r, but heart expresses only pth2. Analysis of mutants showed that Hedgehog (Hh) signaling regulates the expression of pth2 transcripts more than that of nearby gnrh2-expressing cells. Genomic analysis showed that a lizard, chicken, and zebra finch lack a PTH2 gene, which is associated with an inversion breakpoint. Likewise, chickens lack PTH2R, while humans lack PTH3R, a case of reciprocally missing ohnologs (paralogs derived from a genome duplication). The considerable evolutionary conservation in genomic structure, synteny relationships, and expression of zebrafish pth2 and pth2r provides a foundation for exploring the endocrine roles of this system in developing vertebrate embryos. PMID:21880859

  12. 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

  13. Minimal invasive trans-eyelid approach to anterior and middle skull base meningioma: a preliminary study of Shanghai Huashan hospital

    PubMed Central

    Xie, Qing; Wang, Dai-Jun; Sun, Li; Mao, Ying; Zhong, Ping; Zheng, Ming-Zhe; Tang, Hai-Liang; Zhu, Hong-Da; Chen, Xian-Cheng; Zhou, Liang-Fu; Gong, Ye

    2014-01-01

    Transpalpebral or trans-eyelid approach is a modified trans-orbital access to lesions of anterior cranial fossa and sellar region. But whether this approach is also suitable for tumors extending laterally to the temporal lobe or middle cranial fossa is not clarified. We would like to share our experiences from the cadaveric anatomy study to clinical operations. We used 5 cadavers to study trans-eyelid approaches in a step-by-step fashion. And then assisted by an experienced ophthalmologist for incisions, we treated 3 female patients via this approach: One with spheno-orbital meningioma, one with sellar tuberculum meningioma, and the other with medial sphenoidal wing meningioma. After studying the cadavers, we made several revisions to the previously reported approach: 1) move the incision close to the edge of the eyelid, which resembled the double-eyelid incision. 2) A vascularized periosteum flap was dissected for repairing the opened frontal sinus and reconstruction of the skull base. 3) The dura was sutured up with a slice of temporalis muscle. Then we treated 3 patients by this approach. All tumors were totally resected as Simpson Grade I. Complications included orbital apex syndrome and transient oculomotor paralysis because of tumor invasion into orbit and cavernous sinus. No cerebrospinal fluid leakage. We find that trans-eyelid approach is suitable for lesions not only at anterior cranial base or sellar region, but also extending to middle cranial base, especially around sphenoidal wings within 2 cm range or spheno-orbital region. Thus, we propose whether it appropriate to nominate this approach as ‘trans-eyelid pterional approach’, since it may treat some anterior and middle cranial fossa lesions with a mini-craniotomy around pterion. PMID:25550905

  14. 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.

  15. Distribution of cannabinoid receptor 1 in the CNS of zebrafish.

    PubMed

    Lam, C S; Rastegar, S; Strähle, U

    2006-01-01

    The cannabinoid receptor 1 (Cb1) mediates the psychoactive effect of marijuana. In mammals, there is abundant evidence advocating the importance of cannabinoid signaling; activation of Cb1 exerts diverse functions, chiefly by its ability to modulate neurotransmission. Thus, much attention has been devoted to understand its role in health and disease and to evaluate its therapeutic potential. Here, we have cloned zebrafish cb1 and investigated its expression in developing and adult zebrafish brain. Sequence analysis showed that there is a high degree of conservation, especially in residues demonstrated to be critical for function in mammals. In situ hybridization revealed that zebrafish cb1 appears first in the preoptic area at 24 hours post-fertilization. Subsequently, transcripts are detected in the dorsal telencephalon, hypothalamus, pretectum and torus longitudinalis. A similar pattern of expression is recapitulated in the adult brain. While cb1 is intensively stained in the medial zone of the dorsal telencephalon, expression elsewhere is weak by comparison. In particular, localization of cb1 in the telencephalic periventricular matrix is suggestive of the involvement of Cb1 in neurogenesis, bearing strong resemblance in terms of expression and function to the proliferative mammalian hippocampal formation. In addition, a gradient-like expression of cb1 is detected in the torus longitudinalis, a teleost specific neural tissue. In relation to dopaminergic neurons in the diencephalic posterior tuberculum (considered to be the teleostean homologue of the mammalian midbrain dopaminergic system), both cb1 and tyrosine hydroxylase-expressing cells occupy non-overlapping domains. However there is evidence that they are co-localized in the caudal zone of the hypothalamus, implying a direct modulation of dopamine release in this particular region. Collectively, our data indicate the propensity of zebrafish cb1 to participate in multiple neurological processes.

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

    PubMed

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

    2013-08-20

    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

  17. 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.

  18. 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

  19. Ventral tegmental (A10) system: neurobiology. 1. Anatomy and connectivity.

    PubMed

    Oades, R D; Halliday, G M

    1987-05-01

    The VTA contains the A10 group of DA containing neurons. These neurons have been grouped into nuclei to be found on the floor of the midbrain tegmentum--Npn, Nif, Npbp and Nln rostralis and caudalis. The VTA is traversed by many blood vessels and nerve fibers. Close to its poorly defined borders are found DA (A8, A9, A11) and 5-HT containing neurons (B8). Efferent projections of the VTA can be divided into 5 subsystems. The mesorhombencephalic projects to other monoaminergic nuclei, the cerebellum and a fine projection descends to other tegmental nuclei as far as the inferior olive. Fibers to the spinal cord have not been demonstrated. The mesodiencephalic path projects to several thalamic and hypothalamic nuclei and possibly the median eminence. Functionally important examples are the anterior hypothalamic-preoptic area, N. medialis dorsalis and reuniens thalami. These two subsystems are largely non-dopaminergic. A minor mesostriatal projection is overshadowed by the large mesolimbic projection to the accumbens, tuberculum olfactorium, septum lateralis and n. interstitialis stria terminalis. There are also mesolimbic connections with several amygdaloid nuclei (especially centralis and basolateralis), the olfactory nuclei and entorhinal cortex. A minor projection to the hippocampus has been detected. The mesocortical pathway projects to sensory (e.g. visual), motor, limbic (e.g. retrosplenial) and polysensory association cortices (e.g. prefrontal). Prefrontal, orbitofrontal (insular) and cingulate cortices receive the most marked innervation from the VTA. A more widespread presence of DA in other cortices of rodents becomes progressively more evident in carnivores and primates. Most but not all projections are unilateral. Some neurons project to more than one area in mesodiencephalic, limbic and cortical systems. The majority of these fibers ascend in the MFB. Most areas receiving a projection from the VTA (DA or non-DA) project back to the VTA. The

  20. [Comparative volumetric analysis of the principal subdivisions of the telencephalon in saurian reptiles].

    PubMed

    Platel, R

    1980-01-01

    The volumetric measure of the main subdivisions of the telencephalon has been carried on 24 species of Lizards and 2 species of Snakes. The studied structures are termed as follows: main and accessory olfactory bulbs, medial cortex (M 1 and M 2), dorsal cortex (D 1, D 2 and D 3), lateral cortex (L), Septum, Tuberculum olfactorium, dorsal and ventral striatum, amygdala and nucleus sphaericus. The analysis of the datas makes use of the SNEL L's formula which relates the volume of the various telencephalic subdivisions (V) to the somatic weight (S): V = k x S alpha. Each alpha value is compared to the value of the coefficient of allometry (A) of the whole brain. The evolutive (phylogenetic) growth of a structure is said fast (or slow) when its corresponding alpha value is higher (or lower) than the encephalic A value. At the cortical level such analysis shows the progressive nature of the dorsal cortex. A partition of the sample into Lacertomorpha (14 species) and Dracomorpha (10 species) (in agreement with the NORTHCUTT'S definition of his Type I and Type II Lizards) corroborates this cortical detail, more distinctly with the second group as well (especially for the D 2 portion). Moreover the high number of progressive structures among the Dracomorpha leads to consider this group as phylogenetically the most advanced in the Order of Lizards. The somatic indices are calculated according the allometric characteristics of the Reference Lizards. The judicious choice of some species allows to show how the development of a biological function may be expressed by the values of the indices of the related structures. For examples: dorsal cortex, dorsal striatum and mode of locomotion; olfactory bulbs, lateral cortex, part M 1 of the medial cortex and olfactory system; D 3 subdivision of the dorsal cortex and visual performances. The duality between Lacertomorpha and Dracomorpha is therefore corroborated by significant differences found for the various indices of a great