The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome

1983 ◽  
Vol 59 (6) ◽  
pp. 1002-1006 ◽  
Author(s):  
Allan B. Levin ◽  
Lincoln F. Ramirez ◽  
Jordan Katz
Keyword(s):  
Pain Relief ◽  
Diabetes Insipidus ◽  
Pain Syndrome ◽  
Pituitary Hormones ◽  
The Body ◽  
Cerebral Stroke ◽  
Preoperative Pain ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Thalamic Pain Syndrome

✓ Three patients with neurological injuries consistent with cerebral stroke subsequently developed pain over portions of the body contralateral to the injured hemisphere. Stereotaxic chemical hypophysectomy was used in the management of this pain after other surgical procedures and medical management had failed to provide relief. Postoperatively, all patients were treated for hypopituitarism. All developed transient diabetes insipidus, and one patient developed transient right third nerve palsy. No other complications were encountered. All three patients experienced significant pain relief within 48 hours of the procedure. By the date of discharge, two of the three patients reported complete, and the third greater than 80% pain relief. At the initial follow-up visit all patients were essentially pain-free. These patients have now been followed for 58, 39 and 19 months, and remain free of their original pain. During this time the intravenous administration of naloxone has failed to reproduce the preoperative pain. Pituitary function testing 1 year or more following operation demonstrated that none of the patients had an endocrinologically complete hypophysectomy. Recovery from transient diabetes insipidus was not associated with return of the original pain. The mechanism of action of stereotaxic chemical hypophysectomy in the relief of pain related to thalamic lesions remains unknown. The observation that naloxone failed to reproduce the preoperative pain casts doubt on the theory that augmentation of endogenous opiate release is the primary mechanism. Additional observations suggest that pain relief after hypophysectomy may be more directly the result of stimulation of a hypothalamic pain-suppressing mechanism than due to the elimination of pituitary hormones.

Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 38-41 ◽  
Author(s):  
Motohiro Hayashi ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Mikhail Chernov ◽  
Yuichi Takasu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Gamma Knife ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain ◽  
Fine Print

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

2005 ◽  
Vol 102 ◽  
pp. 38-41 ◽  
Author(s):  
Motohiro Hayashi ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Mikhail Chernov ◽  
Yuichi Takasu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Gamma Knife ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain ◽  
Fine Print

Object.Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain.Methods.Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months.Conclusions.An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Pain relief in metastatic cancer other than breast and prostate gland following transsphenoidal hypophysectomy

1977 ◽  
Vol 47 (5) ◽  
pp. 659-662 ◽  
Author(s):  
George T. Tindall ◽  
Daniel W. Nixon ◽  
James H. Christy ◽  
Jimmy D. Neill
Keyword(s):  
Pain Relief ◽  
Metastatic Cancer ◽  
Prostate Gland ◽  
Critical Evaluation ◽  
Pituitary Hormones ◽  
Content Type ◽  
Advanced Carcinoma ◽  
Brain Peptides ◽  
Progression Of Disease ◽  
Fine Print

✓ Hypophysectomy was performed in six patients with advanced carcinoma other than from breast and prostate gland to alleviate pain. Two patients received significant and lasting relief of pain; one achieved relief but died from progression of disease 5 weeks after surgery; one patient, initially relieved, had recurrence of pain 3 months later; one had about 50% relief; and one received no benefit. Possible mechanisms for pain relief include changes in pituitary hormones, prostaglandins, and the newly isolated brain peptides, alpha and beta endorphin. These preliminary observations will require further critical evaluation in a larger series to determine the effectiveness of hypophysectomy in relieving pain in cancer other than from the breast and prostate. The results, nevertheless, do imply that a different approach to pain, namely endocrine manipulation, may be beneficial in certain cancer patients.

Thalamic stimulation for neuropathic pain

1980 ◽  
Vol 52 (4) ◽  
pp. 486-493 ◽  
Author(s):  
Ian M. Turnbull ◽  
Ralph Shulman ◽  
W. Barrie Woodhurst
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
The Body ◽  
The Other ◽  
Technical Problems ◽  
Content Type ◽  
Thalamic Stimulation ◽  
Sensory Nucleus ◽  
Electrode Systems

✓ Eighteen patients with neuropathic pain underwent thalamic electrode implantation. Satisfactory initial pain relief ensued in 14, and their electrode systems were internalized for long-term use. Twelve of the 14 continue to obtain either complete or partial pain relief by regular stimulation. One of the other two patients has had a complete remission of pain, apparently spontaneously, and the other had to have the electrode removed after it retracted from his thalamus on two occasions. The electrodes have been placed in the sensory nucleus of the thalamus where stimulation evokes paresthesias in the painful part of the body. Technical problems consisting of our inability to locate the target in two patients and our failure to fix the electrode adequately in one prevented us from employing the treatment in three patients. The fourth patient had temperature dysesthesia which was not altered during 2 weeks of stimulation.

Effect of age on outcome in patients with cerebral stroke

2020 ◽  
pp. 41-45
Author(s):  
G. R. Kuchava ◽  
E. V. Eliseev ◽  
B. V. Silaev ◽  
D. A. Doroshenko ◽  
Yu. N. Fedulaev
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Neurological Status ◽  
Statistical Correlation ◽  
Multiple Organ ◽  
The Body ◽  
Social Adaptation ◽  
Cerebral Stroke ◽  
Septic Complications ◽  
Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

scholarly journals User-driven efforts in creating knowledge graph information system

2020 ◽  
Vol 36 (2) ◽  
pp. 97-111
Author(s):  
Stanislava Gardasevic
Keyword(s):  
Information System ◽  
Information Seeking ◽  
Information Needs ◽  
Resource Discovery ◽  
The Body ◽  
Knowledge Graph ◽  
Structured Interviews ◽  
Community Members ◽  
Study Objective ◽  
Content Type

Purpose This paper presents the results of a qualitative study that involved students of an interdisciplinary PhD program. The study objective was to gather requirements to create a knowledge graph information system. The purpose of this study was to determine information-seeking practices and information needs of this community, to inform the functionalities of a proposed system, intended to help students with relevant resource discovery and decision-making. Design/methodology/approach The study design included semi-structured interviews with eight members of the community, followed by a website usability study with the same student participants. Findings Two main information-seeking styles are recognized and reported through user personas of international and domestic (USA) students. The findings show that the useful information resides within the community and not so much on the program website. Students rely on peer communication, although they report lack of opportunities to connect. Students’ information needs and information seeking are dependent on their progress through the program, as well as their motivation and the projected timeline. Practical implications Considering the current information needs and practices, a knowledge graph hosting both information on social networks and the knowledge produced by the activities of the community members would be useful. By recording data on their activities (for example, collaboration with professors and coursework), students would reveal further useful system functionalities and facilitate transfer of tacit knowledge. Originality/value Aside from the practical value of this research that is directly influencing the design of a system, it contributes to the body of knowledge on interdisciplinary PhD programs.

Understanding Semantic Web: a conceptual model

2015 ◽  
Vol 64 (1/2) ◽  
pp. 82-100 ◽  
Author(s):  
Michael Calaresu ◽  
Ali Shiri
Keyword(s):  
Semantic Web ◽  
Conceptual Model ◽  
The Body ◽  
Three Dimensional Model ◽  
Conceptual Approach ◽  
Web Based ◽  
Content Type ◽  
Software Applications ◽  
Web Architecture ◽  
The Web

Purpose – The purpose of this article is to explore and conceptualize the Semantic Web as a term that has been widely mentioned in the literature of library and information science. More specifically, its aim is to shed light on the evolution of the Web and to highlight a previously proposed means of attempting to improve automated manipulation of Web-based data in the context of a rapidly expanding base of both users and digital content. Design/methodology/approach – The conceptual analysis presented in this paper adopts a three-dimensional model for the discussion of Semantic Web. The first dimension focuses on Semantic Web’s basic nature, purpose and history, as well as the current state and limitations of modern search systems and related software agents. The second dimension focuses on critical knowledge structures such as taxonomies, thesauri and ontologies which are understood as fundamental elements in the creation of a Semantic Web architecture. In the third dimension, an alternative conceptual model is proposed, one, which unlike more commonly prevalent Semantic Web models, offers a greater emphasis on describing the proposed structure from an interpretive viewpoint, rather than a technical one. This paper adopts an interpretive, historical and conceptual approach to the notion of the Semantic Web by reviewing the literature and by analyzing the developments associated with the Web over the past three decades. It proposes a simplified conceptual model for easy understanding. Findings – The paper provides a conceptual model of the Semantic Web that encompasses four key strata, namely, the body of human users, the body of software applications facilitating creation and consumption of documents, the body of documents themselves and a proposed layer that would improve automated manipulation of Web-based data by the software applications. Research limitations/implications – This paper will facilitate a better conceptual understanding of the Semantic Web, and thereby contribute, in a small way, to the larger body of discourse surrounding it. The conceptual model will provide a reference point for education and research purposes. Originality/value – This paper provides an original analysis of both conceptual and technical aspects of Semantic Web. The proposed conceptual model provides a new perspective on this subject.

scholarly journals Operations management body of knowledge and its relevance to manufacturing and service organizations

2018 ◽  
Vol 25 (4) ◽  
pp. 373-389 ◽  
Author(s):  
Jurandir Peinado ◽  
Alexandre Reis Graeml ◽  
Fernando Vianna
Keyword(s):  
Operations Management ◽  
Lean Manufacturing ◽  
Process Management ◽  
Work Organization ◽  
The Body ◽  
Service Organizations ◽  
Manufacturing Companies ◽  
Content Type ◽  
Service Companies ◽  
Body Of Knowledge

Purpose The purpose of this paper is to assess the differences in importance assigned by manufacturing or service organizations to topics related to operations management and its attendant body of knowledge. Design/methodology/approach The authors did this by cataloguing and analyzing vacancy announcements related to operations management, presented by manufacturing and services companies in major Brazilian human resources websites. Findings The results show that manufacturing companies primarily hire personnel with skills in routine process management, quality management, lean manufacturing, ergonomics and work organization. Service companies generally seek professionals with knowledge and experience in logistics, supply chain management and project management. Research limitations/implications This study presents some limitations that reduce the power of its conclusions. There is some degree of subjectivity in the interpretation of the contents of the analyzed ads. In order to reduce this problem, the authors who did the tabulation of data marked the situations for which there were some doubts about the classification, discussing them with the other author, until they reached a consensus on the best way to classify each one. Originality/value The discussion about the importance assigned by manufacturing and service companies to the topics of operations management is crucial for not only the results obtained, but also to stimulate the debate on topics that comprise or should comprise the body of knowledge of operations management, and the way they are incorporated into business practice. This provides an additional opportunity to reflect on the potential of operations management in supporting business managers now and in the future.

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