scholarly journals The evaluation of pituitary damage associated with cardiac arrest: An experimental rodent model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu Okuma ◽  
Tomoaki Aoki ◽  
Santiago J. Miyara ◽  
Kei Hayashida ◽  
Mitsuaki Nishikimi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pituitary Gland ◽  
Expression Pattern ◽  
Endocrine Function ◽  
Pars Distalis ◽  
Triphenyltetrazolium Chloride ◽  
Cardio Pulmonary Resuscitation ◽  
Organ Systems ◽  
Pars Nervosa ◽  
Over Time

AbstractThe pituitary gland plays an important endocrinal role, however its damage after cardiac arrest (CA) has not been well elucidated. The aim of this study was to determine a pituitary gland damage induced by CA. Rats were subjected to 10-min asphyxia and cardiopulmonary resuscitation (CPR). Immunohistochemistry and ELISA assays were used to evaluate the pituitary damage and endocrine function. Samples were collected at pre-CA, and 30 and 120 min after cardio pulmonary resuscitation. Triphenyltetrazolium chloride (TTC) staining demonstrated the expansion of the pituitary damage over time. There was phenotypic validity between the pars distalis and nervosa. Both CT-proAVP (pars nervosa hormone) and GH/IGF-1 (pars distalis hormone) decreased over time, and a different expression pattern corresponding to the damaged areas was noted (CT-proAVP, 30.2 ± 6.2, 31.5 ± 5.9, and 16.3 ± 7.6 pg/mg protein, p < 0.01; GH/IGF-1, 2.63 ± 0.61, 0.62 ± 0.36, and 2.01 ± 0.41 ng/mg protein, p < 0.01 respectively). Similarly, the expression pattern between these hormones in the end-organ systems showed phenotypic validity. Plasma CT-proAVP (r = 0.771, p = 0.025) and IGF-1 (r = −0.775, p = 0.024) demonstrated a strong correlation with TTC staining area. Our data suggested that CA induces pathological and functional damage to the pituitary gland.

Expression, distribution, regulation and function of IGFs in the ovine fetal pituitary

1995 ◽  
Vol 14 (3) ◽  
pp. 323-336 ◽  
Author(s):  
F Lü ◽  
K Yang ◽  
V K M Han ◽  
J R G Challis
Keyword(s):  
Pituitary Gland ◽  
Endocrine Cells ◽  
Cell Types ◽  
Pars Intermedia ◽  
Pars Distalis ◽  
Paracrine Factors ◽  
Pomc Mrna ◽  
Pars Nervosa ◽  
Igf I ◽  
And Function

ABSTRACT Activation of the fetal pituitary-adrenal axis is crucial for fetal organ maturation and the onset of parturition in sheep. Many factors including corticotrophin-releasing hormone (CRH) and arginine vasopressin secreted from the hypothalamus, and growth factors produced within the pituitary may be involved in the regulation of maturation of the fetal pituitary gland. IGFs have mitogenic and differentiation-promoting capacities in a variety of organs and are synthesized as paracrine factors within developing tissues. However, there is little information concerning the synthesis, distribution, regulation and function of IGFs in the fetal pituitary gland at different times during pregnancy. Therefore, we have localized IGF-I and IGF-II mRNAs and peptides, and determined the effect of cortisol on the level of IGF-II mRNAs in the pituitary glands of developing sheep fetuses. We examined the possible effects of IGFs on corticotroph function in cultures of adenohypophysial cells from term fetuses. Seven species of IGF-II transcripts of 1·2–6·0 kb were identified by Northern blot analysis in the pituitary gland of fetuses between day 60 of gestation and term (day 145). The levels of IGF-II mRNAs did not change significantly during pregnancy, although there was a trend for the presence of higher levels of IGF-II mRNAs at day 60 of gestation. IGF-I mRNA was not detectable. By in situ hybridization, IGF-II mRNA was localized to non-endocrine cells and to cells lining the blood vessels of the pars distalis, to some presumed endocrine cells in the pars distalis and pars intermedia, and to clusters of cells in the pars nervosa. In contrast, IGF-I and IGF-II peptides were detected in the presumed endocrine cells in the pars distalis and pars intermedia but not in the pars nervosa. Incubation of adenohypophysial cells from term fetuses with IGF-I, but not IGF-II, for 48 h increased specific 125I-Tyr-ovine CRH binding. However, neither IGF-I nor IGF-II had any significant effects on the basal or CRH-stimulated immunoreactive (ir)-ACTH output, the level of POMC mRNA or the number of ir-ACTH positive cells. Infusion of cortisol to fetuses starting at day 96 of gestation for 100 h or at days 120–125 of gestation for 84 h did not affect the level of IGF-II mRNAs in the pars distalis but decreased the levels of POMC mRNA. These results are consistent with IGFs having the potential to influence fetal pituitary function, although probably on cell types other than the corticotrophs. The likely sources of IGFs may be predominantly local (IGF-II) or from extrapituitary sources (IGF-I).

Electrical impedance of the pituitary gland

1970 ◽  
Vol 33 (3) ◽  
pp. 304-306
Author(s):  
Nicholas T. Zervas ◽  
Akira Shintani ◽  
Kenneth S. Pickren
Keyword(s):  
Pituitary Gland ◽  
Electrical Impedance ◽  
Pars Distalis ◽  
Content Type ◽  
Pars Nervosa ◽  
Tissue Interface ◽  
Clinical Measurements ◽  
Fine Print

✓ Experimental and clinical measurements of electrical impedance revealed a significant well-delineated difference between the pars distalis and the pars nervosa, providing an accurate and easy means of identifying the tissue interface between these two elements of the pituitary gland.

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

2021 ◽  
pp. 088506662110189
Author(s):  
Merry Huang ◽  
Aaron Shoskes ◽  
Migdady Ibrahim ◽  
Moein Amin ◽  
Leen Hasan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Survival Outcomes ◽  
Pool Data ◽  
Good Neurological Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Over Time

Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

scholarly journals Audits of emergency trolleys’ contents in selected hospitals in Botswana

2012 ◽  
Vol 17 (1) ◽  
Author(s):  
Lakshmi Rajeswaran ◽  
Valerie J. Ehlers
Keyword(s):  
Cardiac Arrest ◽  
Emergency Situation ◽  
Hospital Ward ◽  
Equipment And Supplies ◽  
Staff Members ◽  
Cardio Pulmonary Resuscitation ◽  
Government Hospitals ◽  
Life Threatening ◽  
Hospital Wards

Cardiac arrest is a life-threatening emergency situation. The outcome depends on timely and effective cardio-pulmonary resuscitation (CPR). Successful CPR attempts in hospitals require well-equipped emergency trolleys and properly functioning equipment, as well as staff members skilled in performing CPR. The study aimed to determine whether the emergency trolleys in Botswana’s hospitals’ wards or units met the expected standards. The contents of the emergency trolleys in 20 wards or units of two referral government hospitals in Botswana were audited by using a standardised checklist. No hospital ward or unit had all the expected equipment or drugs on its emergency trolley, some units failed to check their emergency trolleys’ contents daily. All 20 hospital wards or units that participated in this study, needed to improve the contents and maintenance of their emergency trolleys, otherwise in-hospital CPR efforts in Botswana might be doomed to failure, losing lives that could have been saved if emergency trolleys’ equipment and supplies had been up to standard.OpsommingHartarres is ‘n lewensbedreigende noodsituasie. Die uitkoms word bepaal deur tydige en effektiewe kardio-pulmonale resussitasie (KPR). Suksesvolle KPR pogings in hospitale vereis goed toegeruste noodtrollies en toerusting wat behoorlik funksioneer, asook personeellede wat bedrewe is in die uitvoering van KPR. Die studie het gepoog om te bepaal of die noodtrollies in Botswana se hospitaalsale of eenhede aan die verwagte standaarde voldoen. Die inhoud van die noodtrollies in 20 sale of enhede van twee van Botswana se hospitale is ge-ouditeer deur ‘n gestandardiseerde kontrolelys te benut. Geen hospitaalsaal of eenheid het al die verwagte toerusting of drogerye op sy noodtrollie gehad nie, sommige eenhede het nie hulle noodtrollies se inhoud gereeld gekontroleer nie. Al 20 hospitaalsale of eenhede wat aan die studie deelgeneem het, moet die inhoud en instandhouding van hulle noodtrollies verbeter, anders kan in-hospitaal KPR pogings in Botswana tot mislukkings gedoem wees, waardeur lewens verloor word wat gered kon gewees het, indien die noodtrollies se inhoud op standaard was.

Abstract 19: Progressive Metabolic Derangement During Prolonged Resuscitation for Refractory VT/VF Cardiac Arrest and the Relationship to Neurologically Intact Survival With Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jason A Bartos ◽  
Claire Carlson ◽  
Ganesh Raveendran ◽  
Ranjit John ◽  
Tom P Aufderheide ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Metabolic Derangement ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Substantial Decline ◽  
Lactic Acidemia ◽  
First Time ◽  
Neurologically Intact ◽  
Over Time

Background: Multiple studies have shown declining likelihood of neurologically intact survival with prolonged resuscitation with standard CPR. With standard CPR, survival after VT/VF arrest declines from 35-45% at initiation of CPR to 10-20% survival at 30 min. Objective: The aim of this study was to examine the effects of resuscitation duration on neurologically intact survival in the Minnesota Resuscitation Consortium ECPR protocol. Further, the progressive metabolic derangement of prolonged resuscitation was observed for the first time in this population. Methods: Between December 1, 2015 and May 1, 2018, 115 consecutive adult patients with refractory out-of-hospital VT/VF cardiac arrest requiring ongoing CPR were transported to the cardiac catheterization laboratory where ECLS was initiated and coronary angiography and PCI were performed as needed. Patients achieving an organized cardiac rhythm were admitted for further treatment. Results: Overall, 41% of patients receiving full resuscitative efforts were discharged neurologically intact. Neurologically intact survival declined with increasing duration of CPR with 100% survival in patients placed on ECLS within 30 min. Survival declined to 50% within 50 min and 20% within 70 min. Lactic acid and paCO2 increased over time peaking at 15 mmol/L and 72 mmHg, respectively. pH declined accordingly reaching 6.92 at its nadir. paO2 was stable over time but variable between patients. Conclusions: Likelihood of neurologically intact survival declined with increasing duration of CPR for patients going on to receive ECLS. The metabolic profile worsened during prolonged CPR with increasing lactic acidemia and hypercapnia but survival could be achieved with the hemodynamic support provided by ECLS. Together these findings support the need for rapid transport of patients to teams prepared to place ECLS. Substantial decline in survival begins at 30 min of CPR.

scholarly journals Rituximab treatment for isolated IgG4-related hypophysitis in a teenage female

2018 ◽  
Vol 2018 ◽  
Author(s):  
Danielle R Bullock ◽  
Bradley S Miller ◽  
H Brent Clark ◽  
Patricia M Hobday
Keyword(s):  
Endocrine Function ◽  
List Type ◽  
Pituitary Mass ◽  
Related Disease ◽  
Pituitary Dysfunction ◽  
Igg4 Related Disease ◽  
Pituitary Disease ◽  
Appropriate Treatment ◽  
Organ Systems ◽  
Progression Of Disease

Summary IgG4-related hypophysitis is an important diagnostic consideration in patients with a pituitary mass or pituitary dysfunction and can initially present with headaches, visual field deficits and/or endocrine dysfunction. Isolated IgG4-related pituitary disease is rare, with most cases of IgG4-related disease involving additional organ systems. We report the case of a teenage female patient with isolated IgG4-related hypophysitis, diagnosed after initially presenting with headaches. Our patient had no presenting endocrinologic abnormalities. She was treated with surgical resection, prednisolone and rituximab with no further progression of disease and sustained normal endocrine function. This case, the youngest described patient with isolated IgG4-related hypophysitis and uniquely lacking endocrinologic abnormalities, adds to the limited reports of isolated pituitary disease. The use of rituximab for isolated pituitary disease has never been described. While IgG4-related hypophysitis has been increasingly recognized, substantial evidence concerning the appropriate treatment and follow-up of these patients is largely lacking. Learning points: IgG4-related hypophysitis most often occurs in the setting of additional organ involvement but can be an isolated finding. This diagnosis should therefore be considered in a patient presenting with pituitary abnormalities. Most patients with IgG4-related hypophysitis will have abnormal pituitary function, but normal functioning does not exclude this diagnosis. Corticosteroids have been the mainstay of therapy for IgG4-related disease, with other immunosuppressive regimens being reserved for refractory cases. Further research is needed to understand the effectiveness of corticosteroid-sparing regimens and whether there is utility in using these agents as first-line therapies.

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