scholarly journals Outcome of Pituitary Hormone Deficits After Surgical Treatment of Non-functioning Pituitary Macroadenomas (NFPMA)

2021 ◽  
Author(s):  
Orsalia Alexopoulou ◽  
Valérie Everard ◽  
Martine Etoa ◽  
Edward Fomekong ◽  
Stéphane Gaillard ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Primary Treatment ◽  
Endocrine Function ◽  
Pituitary Hormone ◽  
Tumor Diameter ◽  
Sustained Improvement ◽  
One Year ◽  
Postoperative Improvement ◽  
Visual Disturbances ◽  
Pituitary Macroadenomas

Abstract Objectives: Non-functionning pituitary macroadenomas (NFPMA) are benin tumors that cause symptoms of mass effects including hypopituitarism. Their primary treatment is trans-sphenoidal surgery. We aimed to determine the outcome of pituitary hormone deficits after surgical treatment of NFPMA and to identify factors predicting hormonal recovery.Design: We retrospectively included 246 patients with NFPMA diagnosed and operated in one of the two participating centers. All hormonal axes were evaluated except growth hormone (GH). Postoperative improvement of pituitary endocrine function was considered if at least one hormonal deficit had recovered and a lower total number of deficits was observed one year after surgery.Results: 80% (n=197) of patients had one or more pituitary deficits and 28% had complete anterior hypopituitarism. Besides GH, the gonadotropic and thyrotropic axes were the most commonly affected (68% and 62%, respectively). The number of hypopituitary patients dropped significantly to 61% at one year (p<0.001) and a significant improvement was observed for all hormonal axes, except central diabetes insipidus. Among patients with preoperative hypopituitarism, 88/175 (50%) showed improved pituitary function at one year. Both hyperprolactinemia at diagnosis and a lower tumor diameter independently predicted favourable endocrine outcome.Conclusions: Hypopituitarism is present in 80% of patients with NFPMA and nearly half of them will benefit from sustained improvement after surgery. Hyperprolactinae-mia at diagnosis and lower tumor dimensions are associated with favourable endocrine prognosis. This supports the option of early surgery in NFPMA patients with pituitary deficits independent of the presence of visual disturbances.

scholarly journals Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas

2019 ◽  
Vol 131 (4) ◽  
pp. 1142-1151 ◽  
Author(s):  
Maya Harary ◽  
Aislyn C. DiRisio ◽  
Hassan Y. Dawood ◽  
John Kim ◽  
Nayan Lamba ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Tumor Size ◽  
Transsphenoidal Surgery ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Pituitary Hormone ◽  
Tumor Diameter ◽  
Endoscopic Transsphenoidal Surgery ◽  
Gland Volume ◽  
The Relationship

OBJECTIVELoss of pituitary function due to nonfunctional pituitary adenoma (NFPA) may be due to compression of the pituitary gland. It has been proposed that the size of the gland and relative perioperative gland expansion may relate to recovery of pituitary function, but the extent of this is unclear. This study aims to assess temporal changes in hormonal function after transsphenoidal resection of NFPA and the relationship between gland reexpansion and endocrine recovery.METHODSPatients who underwent endoscopic transsphenoidal surgery by a single surgeon for resection of a nonfunctional macroadenoma were selected for inclusion. Patients with prior pituitary surgery or radiosurgery were excluded. Patient characteristics and endocrine function were extracted by chart review. Volumetric segmentation of the pre- and postoperative (≥ 6 months) pituitary gland was performed using preoperative and long-term postoperative MR images. The relationship between endocrine function over time and clinical attributes, including gland volume, were examined.RESULTSOne hundred sixty eligible patients were identified, of whom 47.5% were female; 56.9% of patients had anterior pituitary hormone deficits preoperatively. The median tumor diameter and gland volume preoperatively were 22.5 mm (interquartile range [IQR] 18.0–28.8 mm) and 0.18 cm3 (IQR 0.13–0.28 cm3), respectively. In 55% of patients, endocrine function normalized or improved in their affected axes by median last clinical follow-up of 24.4 months (IQR 3.2–51.2 months). Older age, male sex, and larger tumor size were associated with likelihood of endocrine recovery. Median time to recovery of any axis was 12.2 months (IQR 2.5–23.9 months); hypothyroidism was the slowest axis to recover. Although the gland significantly reexpanded from preoperatively (0.18 cm3, IQR 0.13–0.28 cm3) to postoperatively (0.33 cm3, IQR 0.23–0.48 cm3; p < 0.001), there was no consistent association with improved endocrine function.CONCLUSIONSRecovery of endocrine function can occur several months and even years after surgery, with more than 50% of patients showing improved or normalized function. Tumor size, and not gland volume, was associated with preserved or recovered endocrine function.

Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas

Endocrine ◽  
2021 ◽  
Author(s):  
Orsalia Alexopoulou ◽  
Valérie Everard ◽  
Martine Etoa ◽  
Edward Fomekong ◽  
Stéphane Gaillard ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pituitary Hormone ◽  
Pituitary Macroadenomas

Epicardial cryoablation as surgical treatment for atrial fibrillation: One year follow up in 84 patients

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
R Uhl ◽  
I Marcolino ◽  
E Zimmer ◽  
F Beyersdorf ◽  
E Eschenbruch
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
One Year

Osteosynthesis at pelvic injuries in toy-breed dogs

2020 ◽  
pp. 32-33
Author(s):  
Nikolay I. Antonov ◽  
Keyword(s):  
Surgical Treatment ◽  
Urban Environment ◽  
Pelvic Trauma ◽  
X Rays ◽  
Skeletal Trauma ◽  
Companion Dogs ◽  
Pelvic Injuries ◽  
Behavioral Features ◽  
Osteosynthesis Techniques ◽  
One Year

Pelvic injuries account for 16 to 25% of all skeletal trauma in small pets. Small dogs as companion dogs are now widespread. Unusual exterior and behavioral features have made them popular and at the same time vulnerable in the modern urban environment. The author defined the nature of injuries and adapted technique of transosseous osteosynthesis for the treatment of toy-breed dogs with pelvic trauma. The study of the X-rays in 226 dogs with pelvic injuries demonstrated that toy-breed dogs accounted for 16% of the total. Multiple pelvic trauma was revealed in 95% of them. Surgical treatment was performed in 24 dogs, conservative one - in 13, that amounted to 65% and 35%, respectively. Surgical treatment consisted in open juxtaposing of fragments and focal transosseous and/or internal osteosynthesis with subsequent external fixation using devices of various designs. The external structures were of three types: half-ring support or U-shaped staple, pair of parallel curved plates connected by two threaded rods with each other, and pair of curved plates located bilaterally on both sides of the pelvis and connected by two threaded rods with the help of threaded ends. The terms of fixation for pelvic injuries in toy-breed dogs at the age under one year were 42 days on the average, and in the dogs at the age above one year - 60 days. Surgical treatment in toy-breed dogs with pelvic injuries was performed more often in comparison with conservative one. Pelvic trauma was accompanied by pronounced pain shock. The osteosynthesis techniques used in toy-breed dogs are little traumatic and not limiting functions thereby contributing to recovery of all the structures of pelvis and pelvic limbs.

Health-related quality of life one year after surgical treatment of the type I chronic aortic dissection

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Oksana Kamenskaya ◽  
Asya Klinkova ◽  
Irina Loginova ◽  
Alexander Chernyavskiy ◽  
Dmitry Sirota ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type I ◽  
Health Related Quality ◽  
Chronic Aortic Dissection ◽  
Related Quality ◽  
Health Related ◽  
One Year

scholarly journals POSTFUNDOPLICATION DYSPHAGIA CAUSES SIMILAR WATER INGESTION DYNAMICS AS ACHALASIA

2016 ◽  
Vol 53 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Roberto Oliveira DANTAS ◽  
Carla Manfredi SANTOS ◽  
Rachel Aguiar CASSIANI ◽  
Leda Maria Tavares ALVES ◽  
Weslania Viviane NASCIMENTO
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Chagas Disease ◽  
Water Volume ◽  
Flow Volume ◽  
Water Ingestion ◽  
Idiopathic Achalasia ◽  
One Year ◽  
Over Time

ABSTRACT Background - After surgical treatment of gastroesophageal reflux disease dysphagia is a symptom in the majority of patients, with decrease in intensity over time. However, some patients may have persistent dysphagia. Objective - The objective of this investigation was to evaluate the dynamics of water ingestion in patients with postfundoplication dysphagia compared with patients with dysphagia caused by achalasia, idiopathic or consequent to Chagas' disease, and controls. Methods - Thirty-three patients with postfundoplication dysphagia, assessed more than one year after surgery, together with 50 patients with Chagas' disease, 27 patients with idiopathic achalasia and 88 controls were all evaluated by the water swallow test. They drunk, in triplicate, 50 mL of water without breaks while being precisely timed and the number of swallows counted. Also measured was: (a) inter-swallows interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing flow - volume drunk divided by the time taken; (c) volume of each swallow - volume drunk divided by the number of swallows. Results - Patients with postfundoplication dysphagia, Chagas' disease and idiopathic achalasia took longer to ingest all the volume, had an increased number of swallows, an increase in interval between swallows, a decrease in swallowing flow and a decrease in water volume of each swallow compared with the controls. There was no difference between the three groups of patients. There was no correlation between postfundoplication time and the results. Conclusion - It was concluded that patients with postfundoplication dysphagia have similar water ingestion dynamics as patients with achalasia.

scholarly journals Surgical Treatment of Persistent Fetal Vasculature and Visual Rehabilitation: One-Year Followup

2012 ◽  
Vol 2012 ◽  
pp. 1-2
Author(s):  
N. Kozeis ◽  
K. T. Tsaousis ◽  
D. Gidaris
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Hand Movement ◽  
Good Prognosis ◽  
Posterior Chamber ◽  
Visual Rehabilitation ◽  
Postoperative Course ◽  
Persistent Fetal Vasculature ◽  
One Year ◽  
The One

We present the management and postoperative course of a persistent fetal vasculature (PFV) case. A four-year-old girl visited the Eye Department of Hippokration, General Hospital of Thessaloniki due to reduced visual acuity of her left eye. She was diagnosed with PFV and underwent surgery (lensectomy, capsulorhexis of the posterior capsule, insertion of an intraocular lens in the posterior chamber, and posterior vitrectomy) in order to dissect the PFV. Along with the postoperative medical care, she underwent intensive treatment for amblyopia. The postoperative course was uncomplicated, and the visual acuity of her left eye improved from hand movement to 20/25 with proper correction. Patients with unilateral PFV and gradually deteriorating visual acuity could be good candidates for a combined surgical procedure, as the one described above, with a good prognosis.

scholarly journals Cerebellar metastases – may surgery play a role in the presence of multiple lesions?

2017 ◽  
Vol 31 (2) ◽  
pp. 152-160
Author(s):  
M. Dabija ◽  
V. Dorobăţ ◽  
Alina Paiu
Keyword(s):  
Surgical Treatment ◽  
Life Expectancy ◽  
Operative Time ◽  
Oncological Surgery ◽  
Effective Treatment Option ◽  
Oncological Patients ◽  
Intracranial Metastases ◽  
Cerebellar Lesions ◽  
One Year

Abstract Brain metastases are the most common form of malignancy presence in the CNS having a more frequent appearance than primary brain tumors. Although secondary cerebellar tumors represent only 15% of all intracranial metastases, they are quite frequent among primary oncological patients and pose a challenge for all of the medical caretakers starting with the neurosurgeon. Among those, a small percent of patients have multiple cerebellar lesions and the therapeutic challenge turns into a medical controversy, especially when it comes to surgical treatment taking into consideration that the life expectancy is lower than one year. A key asset which we have on our side is the anatomical vicinity these lesions occur, this leading us to take into consideration eliminating as many lesions in one single operative time as possible without changing the position of the head during surgery. Based on a retrospective study which concluded that patients with resection of all lesions tend to have a longer life expectancy, and on modern concepts of risks and benefits of oncological surgery and surgery in general, we followed up on three patients presenting posterior and even multiple posterior fossa metastases, taking into consideration individual comorbidities, tumor aspects and the possibility/opportunity of surgical treatment. It turned out that surgery is a safe and effective treatment option and should not be considered harmful or aggressive especially because all of the patients which were under study had a favorable post-operative prognostic and an improved quality of life. We emphasize furthermore the importance of complete lesion resection in as few interventions as possible followed up by radiotherapy/chemotherapy as a key in prolonging these patients life expectancy taking into consideration that the outcome is directly related to the number of lesions rather to the location or volume of them.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

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