Raymond's syndrome following petrosal sinus sampling

Summary Inferior petrosal sinus sampling (IPSS) is used to evaluate the pituitary-dependency of Cushing's disease, and to predict the laterality of a microadenoma prior to transsphenoidal operation. A serious complication occured in a 14-year-old boy: he suffered brain stem ischaemia with abducens nerve palsy and hemiparesis (Raymond's syndrome). The case prompted us to reconsider the indication for this investigation.     

Specific response to adrenaline in arterial hypertension induced by exogenous calcium deficiency

Injection of a synthetic analog of parathyroid hypertensive factor to WKY rats considerably increases and prolongs pressor response to adrenaline. Synthetic analog injected after adrenaline induces a short-term (3–4 min) and potent (to 250%) rise of arterial pressure. Each subsequent injection of the synthetic analog induces a less pronounced in the amplitude and duration pressor response. The α-adrenoblocker phentolamine completely abolishes the effects of the parathyroid hypertensive factor analog. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 124, No. 8, pp. 148–150, August, 1997     

Primary Aldosteronism

ABSTRACT A follow-up examination was performed one month to 20 years after adrenalectomy in 28 cases with surgically treated primary aldosteronism due to adrenal adenoma. The mean age at diagnosis was 45, and the mean duration of hypertension seven years. Severe hypertension with a diastolic blood pressure of 130 mmHg or more was observed in 35%. Postoperatively cerebrovascular catastrophe developed in two cases, both of which belonged to the group of patients with severe hypertension. Normalization of blood pressure was observed in 70% and in the remaining subjects the blood pressure was lower than at diagnosis. The blood pressure response to adrenalectomy appeared unpredictable in view of such parameters as the initial blood pressure, age at diagnosis, and duration of the hypertensive state. Toxicosis during pregnancy and metrorrhagia was observed with unexpectedly high frequency in this study population. Low ambulatory plasma renin activity was recorded at the follow-up in 15 out of 18 subjects studied in the absence of evidence of hyperaldosteronism.     

Relationship of Diet to Small and Large Adenomas of the Sigmoid Colon

The relation of dietary factors to the risk of adenomas of the sigmoid colon was examined in men receiving a retirement health examination at the Self-Defense Forces Fukuoka Hospital between October 1986 and 1990. A total of 187 adenoma cases and 1557 controls with normal colonoscopy were identified in the series. Cases were further classified into small-adenoma (<5 mm, n=78) and large-adenoma (≥5 mm, n=67) groups. The consumptions of selected foods and beverages were ascertained before colonoscopy by means of a self-administered questionnaire. After adjustment for smoking, alcohol use, rank and body mass index, low rice consumption and high meat intake were independently associated with an increased risk of large adenomas. The risk of small adenomas was not related to either rice consumption or meat intake. Adjusted odds ratios of large adenomas for the low, intermediate and high consumption levels of rice were estimated to be 1.0 (referent), 0.83 and 0.43, respectively (trend P = 0.08), and the corresponding figures for meat consumption were 1.0 (referent), 1.58 and 2.38, respectively (trend P =0.02). The findings suggest that low rice consumption and high meat intake may promote the growth of colon adenomas, thereby increasing the risk of colon cancer.     

Intra-vascular tumour in pleomorphic adenomas—a report of four cases

Aims : The aim of this study was to report four cases of pleomorphic adenoma which were characterized by intra-vascular tumour. Methods and results : The patients ranged in age from 13–43 years, one was male while three were female. The tumours were situated in the parotid gland, submandibular gland and palate (two cases). The intra-vascular tumour consisted of single, clustered and solid cords of cells within multiple muscular walled blood vessels and capillaries both in the capsule and in the tumour. Immunoperoxidase staining confirmed that the intra-vascular cells were phenotypically identical to those of the tumour. The possibility that the intra-vascular tumour represents artefactual 'spillage' has been considered, however there is some histological evidence suggesting that this phenomenon represents true vascular invasion. Conclusions : The biological significance of intra-vascular tumour in pleomorphic adenomas is unknown. Thus far there has been no correlation with either recurrence or metastases.     

伽玛刀治疗垂体大腺瘤临床分析(附30例报告)

目的 研究伽玛刀治疗垂体大腺瘤的效果及影响疗效的因素。方法 30例垂体大腺瘤病人用1．0T磁共振定位，Gamma-plan计划系统规划，等剂量曲线45％～60％(平均49．7％)，周边剂量12～35Gy(平均22.9Gy)，中心剂量24～70Gy(平均45．4Gy)．Leksell伽玛刀实施放射外科治疗。分析治疗后垂体大腺瘤病例，总结其疗效和影响疗效的因素。结果 随访12～60个月，平均28个月，肿瘤完全消失6例(20％)，肿瘤缩小19例(63．3％)，无变化5例(16．7％)；19／20(95．5％)功能性垂体腺瘤内分泌症状改善，临床症状好转，1例过早绝经(年龄36岁)；5／10(50％)无功能性垂体腺瘤体积缩小．症状改善。结论 伽玛刀对于垂体大腺瘤仍是一种有效的治疗方法，其疗神与腺瘤的举类型、体积、照射剂量、剂量体剂、MRI信号特征密切相姜。     

Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study.

BACKGROUND: The natural history of parathyroid function after successful renal transplantation (RT) and the factors predisposing to persistent hyperparathyroidism (HPT) are not well established. A better knowledge of these data may be helpful in the development of algorithms for optimal surveillance and treatment of HPT after successful RT. Our aim was to evaluate the post-transplant natural history of parathyroid function and calcium metabolism in patients with a functional renal graft and to identify risk factors for persistent HPT. METHODS: Charts of 1165 allograft kidney recipients transplanted between 1989 and 2000 were reviewed. Patients with an intact parathyroid hormone (iPTH) level available at the time of transplantation were identified. The charts of the latter patients were checked for a variety of demographic and clinical data, and all determinations of the iPTH concentration available since transplantation were recorded. Serum levels of calcium, phosphorus, alkaline phosphatases and creatinine, concurrently determined, were also registered. RESULTS: After an initial fall, iPTH levels showed a slow but steady decline towards the upper normal limit. The prevalence of persistent HPT, defined as an iPTH level > or =2.5 times the upper normal limit or the need for parathyroidectomy following transplantation, remained stable at approximately 17% up to 4 years after transplantation. Patients with persistent HPT had significantly elevated serum levels of iPTH, calcium and phosphorus at the time of RT, and had spent a longer time on dialysis. Post-transplant iPTH levels correlated significantly with transplant kidney function. CONCLUSION: Kidney transplant recipients with a high iPTH and calcium x phosphate product at the time of transplantation are at risk for persistent HPT especially when renal function is suboptimal. Therapy for persistent HPT, if considered, should be initiated 3 months post-transplantation since further spontaneous improvement of parathyroid function thereafter is limited.     

显微镜下经单鼻孔蝶窦入路切除垂体腺瘤

目的评价显微镜下经单鼻孔蝶窦入路切除垂体腺瘤的疗效. 方法采用经单鼻孔蝶窦入路行垂体腺瘤切除术20例,其中微腺瘤8例(<10 mm),小腺瘤8例(10～20 mm),中腺瘤3例(20～30 mm),大腺瘤1例(>30 mm);PRL腺瘤9例,GH腺瘤6例,ACTH腺瘤5例. 结果本组20例无并发症,平均随访5(2～10)个月,患者临床症状较术前均有不同程度改善,手术效果良好. 结论经单鼻孔蝶窦入路垂体瘤切除术效果好,术中损伤小,患者痛苦少,术后康复快,没有或较少出现并发症.     

垂体腺瘤性男性不育

垂体腺瘤是男性不育的重要病因。现代内分泌和影像学检查能够早期诊断垂体腺瘤引起的男性不育症。针对垂体腺瘤的病因治疗是治疗此类不育症的最佳选择。