No abstract available.
Hypophysectomy*

Recently, transsphenoidal approach is regarded as the principal method for the resection of pituitary tumor. The sublabial transseptal transsphenoidal hypophysectomy is a classical one, but it has certain limitations and postoperative problems. So various modifications of transsphenoidal hypophysectomy have been proposed. The columellar flap is one of such modified approaches.
Hypophysectomy ; Pituitary Neoplasms

BACKGROUND AND OBJECTIVES: Various surgical approach has been used for the removal of pituitary tumor. Recently, endoscopic transnasal transsphenoidal approach has been technically upgraded and the morbidity associated with surgical treatment of the pituitary tumor has been decreased. The objectives of our study was to describe surgical techniques and materials used in sellar repair after endoscopic transnasal transsphenoidal approach. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 18 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between November 2002 and January 2004. We evaluated effectiveness of this technique by analyzing surgical techniques, symptom improvement and complications after surgery. RESULTS: In most of the case, tumor was found to be macroadenoma and 8 of the cases had suprasellar extension. Tumor was totally removed in 13 cases and partially removed in 5 cases. In all cases we used endoscopic unilateral transnasal transsphenoidal approach with anterior sphenoidotomy. CONCLUSION: We may consider that this approach is more safe and effective and a better treatment method for pituitary tumor surgery than the transcranial approach.
Endoscopy ; Humans ; Hypophysectomy* ; Medical Records ; Pituitary Neoplasms* ; Retrospective Studies

Pituitary abscess may be caused by direct extension of contiguous infections from purulent sphenoid sinusitis, meningitis or cavernous sinus thrombophlebitis. It also develop after craniotomy or transsphenoidal hypophysectomy. In some cases, it was associated with primary pituitary tumor or cyst which were vulnerable to infection because of impaired circulation, areas of necrosis or local immunological impairment. Primary pituitary abscess may also occur without any preceding infection. Since the clinical features, computed tomographic findings, and laboratory data of primary pituitary abscess were similar to pituitary tumor, preoperative diagnosis of pituitary abscess is difficult. Inhomogenous enhancement with central low density and focal bulge at the level of diaphragm was reported to be compatible with computed tomographic findings of pituitary abscess.
Abscess* ; Cavernous Sinus Thrombosis ; Craniotomy ; Diagnosis ; Diaphragm ; Hypophysectomy ; Meningitis ; Necrosis ; Pituitary Neoplasms ; Sphenoid Sinus ; Sphenoid Sinusitis

From March, 1984 to August, 1991, 16 patient were diagnosed as Cushing's disease and 14 of them were treated by transsphenoidal microsurgical procedure. Preoperrative endocrinological evaluation included plasma level of ACTH, serum cortisol concentration, urinary free cortisol and 17-hydroxycorticosteroid, dexamethasone suppression test and bilateral sampling of the inferior petrosal sinuses(IPS). The sensitivity of the last method was 88% for Cushing's disease but the expected laterality with the test was not always consistent with the surgical results. High resolution computed tomography(CT) and high field magnetic resonance imaging(MRI) were done as imaging devices. We cannot tell MRI is superior to CT is diagnosing microadenomas. All operations were performed through transsphenoidal approach. A selective microadenomectomy was done in 8 patients and all of them showed remission. A partial adenomectomy was done in 4 cases. Hypophysectomy was done in 2 cases, one of which was a failed case after the first trial and the other was one with no apparent tumor tissue in 7 successive frozen biopsies during operation. Overall surgical remission rate was 86.
Adrenocorticotropic Hormone ; Biopsy ; Dexamethasone ; Humans ; Hydrocortisone ; Hypophysectomy ; Magnetic Resonance Imaging ; Plasma

In the treatment of breast cancer, especially in estrogen receptor (ER) positive patients, endocrine therapy has played an important role since bilateral oophorectomy, the first endocrine therapy, was performed by George Thomas Beaston in 1896. Thereafter, various therapeutic modalities such as radiation therapy to ovaries, surgical or medical adrenalectomy, or hypophysectomy, have been used for endocrine therapy in breast cancer. The discovery of ER and the development of anti-estrogens represent substantial progress, and tamoxifen, the first selective ER modulator, has become the gold standard in the endocrine therapy of breast cancer. The therapeutic effects of tamoxifen were confirmed by the 1995 Oxford overview. Recently, the 7th International Conference on Adjuvant Therapy of Primary Breast Cancer held in St. Gallen, Switzerland, recognized the increasing role played by endocrine therapy in properly selected patients groups, especially in younger patients with ER-positive tumors. In addition, recent advances in estrogen research and ER function at the molecular level have provided new strategies as well as a better understanding of endocrine therapy for breast cancer. Lately, new hormonal agents, such as the third-generation aromatase inhibitors, and ER downregulators, showed equivalent or better results in terms of therapeutic effects than tamoxifen. As a result, many clinical trials are ongoing to determine the most appropriate endocrine therapy for breast cancer. Therefore, it is important to maximize the benefits of endocrine therapy in clinical practice in terms of the patient's quality of life as well as the prolongation of patient survival. More studies are needed to determine optimal agents and the duration of therapy, combinations of agents or sequences of therapy according to prognostic and predictive factors.
Adrenalectomy ; Aromatase Inhibitors ; Breast Neoplasms* ; Breast* ; Estrogens ; Female ; Humans ; Hypophysectomy ; Ovariectomy ; Ovary ; Quality of Life ; Switzerland ; Tamoxifen

BACKGROUND AND OBJECTIVES: The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. SUBJECTS AND METHOD: A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. RESULTS: EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. CONCLUSION: EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.
Acceleration ; Endoscopes ; Hand ; Humans ; Hypophysectomy ; Learning ; Learning Curve ; Length of Stay ; Pituitary Neoplasms ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Transseptal transsphenoidal approach has been used for the surgical removal of pituitary tumor. However, it may have a chance of complications following septal surgery. Recently, endoscopic transnasal transsphenoidal approach was attempted with several advantages. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 10 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between December, 1994 and August, 1998. We evaluated the effectiveness of this technique by analyzing operative findings, operative techniques, symptoms improvement and complications after surgery. RESULTS: In most cases, tumor were over 10 mm in diameter. Four patients had received previous transseptal transsphenoidal hypophysectomy. This technigre reduced the postoperative morbidity and compli-cations of transseptal approach. Another advantage of this technique was to examine operative site directly in outpatient clinic. CONCLUSION: We may consider that this approach is safe and effective, especially in revision cases after previoustransseptal surgery.
Ambulatory Care Facilities ; Humans ; Hypophysectomy ; Medical Records ; Pituitary Neoplasms ; Retrospective Studies

BACKGROUND AND OBJECTS: Transseptal transsphenoidal hypophysectomy with nasal columellar flap is now a widely used method with acceptable morbidity, However, a considerable number of patients complain of nasal symptoms after the operation and postoperative complications are continuously reported. The authors analyzed the different types of postoperative symptoms and their incidences. OBJECTS AND METHODS: We interviewed 105 patients (39 male and 66 female) via telephone who have been followed up for more than 1 year. Interviews were proceeded by questionnaires. RESULTS: Among the postoperative symptoms, the most frequent symptom was nasal obstruction (19.0%), followed by hyposmia (17.1%), nasal crust (15.2%), rhinorrhea/headache (12.4%), and upper lip numbness (10.5%). CONCLUSION: On the basis of these clinical experiences, it would be necessary, before undergoing transeptal transsphenoid hypophysectomy, to let patients know and prepare themselves of possible postoperative nasal spnptoms.
Humans ; Hypesthesia ; Hypophysectomy* ; Incidence ; Linear Energy Transfer ; Lip ; Male ; Nasal Obstruction ; Postoperative Complications ; Surveys and Questionnaires ; Telephone

Recent studies have revealed that IGF- I produced in kidney are of two fractions; GH dependent and GH nondependent IGF-I. The role of GH nondependent IGF-I is interesting in renal hypertrophy and glomerulosclerosis because GH is clearly related with hypertrophy accompanying glomerulosclerosis is not seen in GH deficient animal. The relationship of the high protein diet and the IGF- I production under the deprivation of GH was studied. In hypophysectomized Sprague-Dawley rat, the level of serum IGF-I was measured using radioimmunoassay, and renal IGF- I production evaluated by immunohistochemistry during both normal and high protein diet. Serum IGF-I of rats on high protein diet was significantly higher than that fed normal protein diet. After unilateral nephrectomy, the level of serum IGF-I was significantly increased in both normal and high protein diet groups. Henle's loop, distal convoluted tubule and collecting duct were weakly stained with normal protein diet. With high protein diet, the staining intensities increased at these portion , and distal part of proximal convoluted tubule and straight tubule were weakly stained. After unilateral nephrectomy, distal convoluted tubule and collecting duct were densely stained with normal protein diet. With high protein diet, the staining intensities increased in distal part of proximal convoluted tubule and Henle's loop. Regardless of the types of protein diet, the specific difference between unilateral nephrectomized rats and sham- operated rats was immunoreactivity of the distal convoluted tubule.. In conclusion, it is suggested that GH non-dependent IGF-I is mainly produced in distal convoluted tubule during compensatory renal hypertrophy, and protein diet mainly affect IGF- I production of distal part of proximal convoluted tubule and Henle's loop.
Animals ; Diet ; Growth Hormone* ; Hypertrophy ; Hypophysectomy ; Immunohistochemistry ; Insulin-Like Growth Factor I ; Kidney* ; Nephrectomy ; Radioimmunoassay ; Rats ; Rats, Sprague-Dawley