Cerebrospinal fluid rhinorrhoea in pituitary tumours

Three cases of CSF rhinorrhoea due to pituitary tumours are reported and the literature reviewed. The treatment of choice appears to be trans-sphenoidal exploration of the pituitary fossa with insertion of a free muscle graft followed by radiotherapy. The probability of the tumour being a prolactin-secreting adenoma is discussed.     

神经外科术后颅内感染患者脑脊液培养结果分析

目的 分析神经外科术后颅内感染患者脑脊液的病原菌特征,探讨感染的相关因素.方法 回顾性分析482例神经外科术后患者的临床资料、感染率和感染相关因素及病原菌特征.结果 482份脑脊液标本,培养阳性71例,阳性率为14.72％;共分离出病原菌83株,革兰阳性菌44株,占53.01％,革兰阴性菌36株,占43.37％,真菌3株,占3.61％;分布最多的3种病原菌为凝固酶阴性葡萄球菌、鲍氏不动杆菌和金黄色葡萄球菌,分别占31.33％、16.87％和14.46％;单因素x2检验显示,颅内感染与糖尿病、开放性颅脑损伤、脑脊液漏和脑室外引流有关(P＜0.05).结论 凝固酶阴性葡萄球菌是神经外科术后颅内感染的主要致病菌,应针对相关易感因素,加强微生物监测、合理有效预防颅内感染.     

尖吻蝮蛇血凝酶(苏灵)在经鼻蝶垂体瘤切除术后的疗效观察

目的 研究探讨苏灵在经鼻蝶垂体瘤切除术后的止血效果.方法 收集某院住院并采用经鼻碟垂体瘤切除术的患者158人,分为两组,实验组手术前使用苏灵进行提前止血,对照组使用立止血在术前进行止血.术后检测患者的凝血系统功能指标,肝肾功能指标,血常规指标以及术中出血和术后再出血情况.结果 使用苏灵组的患者在血常规,肝肾功能和凝血系统指标上面和传统药物立止血并无差异,但是使用苏灵组患者止血时间为(37.3±22.1)s,切口出血量(1.83±1.34)g,切口单位面积出血量为(0.042±0.02) g·cm-2,17例患者出现再出血.使用立止血组患者止血时间为(47.3±19.4)s,切口出血量(3.21±1.50)g,切口单位面积出血量为(0.084±0.01) g·cm-2,28例患者出现再出血.结论 苏灵在经鼻蝶入路垂体瘤切除术前使用具有安全性和有效性.     

Persistent trigeminal artery associated with pituitary adenoma

The authors report of a case with a pituitary macroadenoma which was associated with a persistent trigeminal artery. The tumour was removed by transsphenoidal microsurgical approach to the sella turcica. To recognise the developmental anomaly is very important to avoid complications during operation.     

The presence of macromolecular prolactin in serum of pregnant women and patients with pituitary adenoma

The heterogeneity of immunoreactive Prolactin (IR-PRL) in serum of pregnant women and patients with pituitary adenoma were studied by Sephadex G-100 gel chromatography. The major IR-PRL peaks in serum of pregnant women were eluted at the position corresponding to that of 125I-PRL and the small amount of IR-PRL peaks were eluted near the void volume (peak 1) and between the void volume and 125I-PRL (peak 2). On the other hand, the proportion of peak 1 and peak 2 to total immunoreactivity was significantly increased in serum of patients with pituitary adenoma compared to those in serum of pregnant women. The rechromatographic studies under conditions of protein denaturation and sulfide cleavage on Sepharose CL-6B column revealed that the peak 1 of the pregnant women and patients with pituitary adenoma were eluted at the position between 125I-AFP and ovalbumine and the molecular weight was estimated to be about 54,000. This macromolecular PRL was also bound specifically to Sepharose coupled with anti-PRL, indicating that this macromolecule contained a sequence of PRL in its structure.     

Cerebrospinal fluid changes in tetanus: raised proteins and immunoglobulins in patients with severe disease

34 patients with tetanus were studied; all had normal serum proteins and albumin. Only 3 samples of cerebrospinal fluid (CSF) contained cells (a few polymorphonuclear leucocytes). Protein levels in the CSF were elevated in 26 patients (76.5%); 11 cases with clinically mild tetanus had a mean CSF protein of 400 +/- 250 mg/litre (normal 100-400 mg/litre), while the CSF protein levels of 10 patients who died (mean 1596 +/- 985 mg/litre; P less than 0.005) and those of 4 others with severe disease who absconded were much higher (mean 1220 +/- 562 mg/litre; P less than 0.005). As a group, 19 patients with severe disease including the 10 fatal cases also had significantly higher mean CSF protein values (1582 +/- 938 mg/litre; P less than 0.005) than did the mild cases. Immunochemical analysis of the proteins using a radial immunodiffusion assay showed that these proteins were immunoglobulin G (IgG). Polyacrylamide gel electrophoresis demonstrated an oligoclonal gammaglobulin pattern, suggesting intrathecal IgG synthesis in these patients. These studies suggest that measurement of CSF proteins may supplement clinical evaluation in tetanus and that there may be a local immune stimulus (perhaps a tetanus antigen or to some other mitogen) in the central nervous system.     

Cerebrospinal fluid proteins and free amino acids in patients with solvent induced chronic toxic encephalopathy and healthy controls.

The concentrations of protein, albumin, IgG, and free amino acids in the cerebrospinal fluid of 16 patients with chronic toxic encephalopathy due to organic solvents were measured. The patient group consisted of all patients with this diagnosis in a neurological department in 1985. The diagnosis was based on neuraesthenic symptoms, pathological psychometric performance, and verified exposure to neurotoxic organic solvents. A control group of 16 patients with myalgias or backache, or both, and no signs of disease was used for comparison. The purpose was to study possible changes in the cerebrospinal fluid that might contribute to understanding the aetiology of solvent induced chronic toxic encephalopathy. A rise in protein, albumin, and IgG was found in the patient group compared with the control group, as well as reduced concentrations of phosphoethanolamine, taurine, homocarnosine, ethanolamine, alpha-aminobutyric acid, and leucine. Using a stepwise multiple regression analysis, taurine was negatively correlated to exposure to solvents. These findings may indicate membrane alterations in the central nervous system related to exposure to organic solvents.     

Cerebrospinal fluid ascorbic acid levels during the neonatal period.

Corresponding plasma and cerebrospinal fluid ascorbic acid levels were determined in 13 term and 17 preterm newborn infants during the neonatal period. On the first day of life preterm C.S.F ascorbate value of 5.2 +/- 0.8 mg/dl (mean +/- S.E.) was higher than the 3.8 +/- 0.3 mg/dl value in term infants (P less than 0.1). Later determinations during the neonatal period did not demonstrate a difference between term and preterm C.S.F ascorbate values and levelled at 2.9 +/- 0.2 mg/dl. There was a significant negative correlation between the C.S.F/plasma ascorbate ratio and the plasma ascorbate levels and the shape of the regression line was suggestive of a saturable active ascorbate transport from the plasma into the cerebrospinal fluid. Ascorbic acid in the C.S.F of additional six neonates with a neurological disorder was lower than expected on the basis of their plasma levels, the C.S.F/plasma ascorbate ratios being 8.3 +/- 0.9 in the apparently normal infants and 3.7 +/- 0.6 in the neurological patients, (P less than 0.025). The possible mechanism of ascorbate loss from the central nervous system is discussed and it is speculated that ascorbic acid administration following a neurological insult may prove beneficial.     

Health-related quality of life in patients with non-functioning pituitary adenoma: a special focus on hydrocortisone replacement dose

Quality of Life Research - Patients with non-functioning pituitary adenomas (NFPA) suffer from pronounced impairments in physical and mental measures that result in an impairment of health-related...     

Cerebrospinal fluid angiotensin converting enzyme levels in the diagnosis of neurosarcoidosis.

Cerebrospinal fluid angiotensin converting enzyme (CSF-ACE) level was measured in two patients considered to have neurosarcoidosis, three patients with possible neurosarcoidosis and in 38 control patients suffering from prolapsed intervertebral discs. Both neurosarcoidosis patients had elevated levels (1.8 and 5.4 mumol/l/min) while the possible neurosarcoidosis patients had values similar to the control patients (mean 0.59 +/- 0.42 mumol/l/min). We suggest that CSF-ACE values may be of use in some patients as a diagnostic test for neurosarcoidosis and provide a reference range of normal controls.