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Biomedical subjects

E W Hoving

Publications and source records attributed to E W Hoving.

9 recordsLinked to original sources
PubMed2005

[Pituitary apoplexy: an endocrinologic emergency].

A 32-year-old woman, a 73-year-old man and a 26-year-old pregnant woman presented with headache, vomiting, and variable presence of visual disturbances, impaired consciousness, and circulatory shock. All three had pituitary apoplexy. In the first patient lymphocytic hypophysitis was diagnosed, the second had a nonfunctional adenoma and the last patient probably also. All three patients were treated conservatively with full recovery of signs and symptoms. However pituitary insufficiency remained in all three. Pituitary apoplexy is an acute event with significant morbidity and mortality. The cause is a rapid expansion of, usually, a pre-existing, often not yet known, adenoma by massive haemorrhage or infarction. Pressure, among other things, causes hypopituitarism, meningism, compression of the chiasma opticum and visual disturbances. Although many predisposing factors have been identified, pituitary apoplexy is often an unpredictable event. Diagnosis is made by the typical clinical presentation, eye examination, MRI and by measuring pituitary hormones. Treatment is with suppletion of the deficient hormones and in selected patients by transsphenoidal decompression surgery.

Adenoma↗
PubMed2003

Proliferation and aneusomy predict survival of young patients with astrocytoma grade II.

The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histological characteristics. As one of the best prognostic factors, higher age identifies rapid progressive A II. For patients over 35 years of age, an aggressive treatment is normally propagated. For patients under 35 years, there is no clear guidance for treatment choices, and therefore also the necessity of histopathological diagnosis is often questioned. We studied the additional prognostic value of the proliferation index and the detection of genetic aberrations for patients with A II. The tumour samples were obtained by stereotactic biopsy or tumour resection and divided into two age groups, that is 18-34 years (n=19) and > or =35 years (n=28). Factors tested included the proliferation (Ki-67) index, and numerical aberrations for chromosomes 1, 7, and 10, as detected by in situ hybridisation (ISH). The results show that age is a prognostic indicator when studied in the total patient group, with patients above 35 years showing a relatively poor prognosis. Increased proliferation index in the presence of aneusomy appears to identify a subgroup of patients with poor prognosis more accurately than predicted by proliferation index alone. We conclude that histologically classified cases of A II comprise a heterogeneous group of tumours with different biological and genetic constitution, which exhibit a highly variable clinical course. Immunostaining for Ki-67 in combination with the detection of aneusomy by ISH allows the identification of a subgroup of patients with rapidly progressive A II. This is an extra argument not to defer stereotactic biopsy in young patients with radiological suspicion of A II.

Adolescent↗
PubMed2000

[Posttraumatic syringomyelia in 2 patients with thoracic spinal cord lesions].

Two patients, men aged 42 and 40 years, developed new neurological symptoms 3 months and 22 years, respectively, after a traumatic high thoracic spinal cord injury. The MRI scan showed a cavity in the central part of the spinal cord, on which the diagnosis of 'posttraumatic syringomyelia' could be based. In one of the patients a syringo-subarachnoidal shunt was created, the other was treated conservatively because of a severe concomitant thoracic kyphosis. Posttraumatic syringomyelia is a potentially life-threathening late complication of spinal cord injury and is characterized by development of new neurological symptoms after a variable time interval. The most typical symptom of non-traumatic syringomyelia, viz. diminution of vital sensitivity without loss of gnostic sensitivity, is not necessarily present in posttraumatic syringomyelia. Surgical treatment of posttraumatic syringomyelia is advocated if there is progressive neurological deterioration, and consists of drainage of the syrinx.

Adult↗
PubMed2000

Nasal encephaloceles.

Nasal encephaloceles can be divided into frontoethmoidal and basal encephaloceles. Both conditions are very rare, but frontoethmoidal encephaloceles show a relatively high incidence (1:5,000) in Southeast Asia. The pathogenesis of encephaloceles may be explained by a disturbance in separation of surface ectoderm (epithelial layer) and neurectoderm (nervous tissue) in the midline just after closure of the neural folds. It should be regarded as a 'late' neurulation defect taking place during the 4th gestational week. Apoptosis appears to be related to this separation process. Frontoethmoidal encephaloceles can be recognized as a facial mass covered with normal skin, while basal encephaloceles may cause nasal obstruction or symptoms related to herniation of basal structures. Diagnostic CT or MR imaging delineates the anatomy of the herniated mass. Therapy for frontoethmoidal encephaloceles consists in excision of the cele, watertight closure of the dural defect and reconstruction of the skull defect. Basal encephaloceles may harbour vital herniated structures which should be saved. Hydrocephalus should be dealt with first, followed by elective single-stage reconstructive surgery. The prognosis appears to be better for patients with frontoethmoidal encephaloceles than for patients with occipital or parietal encephaloceles, and it depends largely on the presence of additional congenital anomalies of the brain. The differential diagnosis of a nasal mass must include nasal glioma, dermoid cyst, and nasal polyp.

Child↗
PubMed1997

Frontoethmoidal encephaloceles, a study of their pathogenesis.

A prospective clinical study of 30 patients with frontoethmoidal encephaloceles was performed in order to find support for a proposed theory concerning its pathogenesis, based on a previously performed embryological study and relevant findings in the literature. According to this proposed theory the pathogenesis of frontoethmoidal encephaloceles is primarily based on a disturbance in separation of neural and surface ectoderm at the site of final closure of the rostral neuropore during the final phase of neurulation in the 4th week of gestation. An insufficient occurrence of apoptosis might cause this disturbance in separation. The nonseparation of neural and surface ectoderm will result secondarily in a midline mesodermal defect. This mesodermal defect is reflected in the median skull defect at the site of the foramen caecum. The outgrowth of the nasal septum with the concomitant forward displacement of epidermis (surface ectoderm) and attached brain tissue (neural ectoderm) may act as herniating force. The patient study consisted of a clinical investigation, radiological investigations (X skull and CT scans), and surgical treatment in order to obtain specimens which were examined histologically. Clinical findings supportive of the proposed hypothesis are (1) the consistency in the location of the internal skull defect, (2) the close relationship between epidermal structures and glial tissue in 15 out of 29 specimens, and (3) the presence of a normally developed nose in combination with interorbital hypertelorism in all patients. A discussion of these findings is presented with special reference to the embryological aspects.

Abnormalities, Multiple↗
PubMed1990

Separation of neural and surface ectoderm after closure of the rostral neuropore.

Separation of neural and surface ectoderm after closure of the rostral neuropore in the head region has been described by investigating the integrity of the basement membranes of these epithelia in 11- to 27-somite rat embryos. The basement membranes were visualized with polyclonal antibodies against laminin. Furthermore, cell degeneration has been investigated in relation to neural crest activity, and discontinuities of the basement membrane in 9- to 30-somite mouse embryos. The separation of the basement membranes of neural and surface ectoderm in the midline is a final phase during the fusion of the neural folds, which takes place from the closure of the rostral neuropore, at the 19-somite stage, until the 27-somite stage (rat embryos), and which occurs focally with variation in the midsagittal and the transverse planes. In the prosencephalon, neural crest activity is absent during the separation phase of both epithelia, but cell degeneration may contribute to the separation of the initially connected basement membranes. A disturbance in the separation of the neural and surface ectoderm may be the pathogenetic basis of midline skull defects, and of the fronto-ethmoidal encephalocele in particular.

Animals↗
PubMed1989

Functional anatomy of the vagina fibrosa of the flexors of the fingers.

The flexor tendon sheaths of 40 fingers were investigated to determine which classification of the annular and cruciform pulleys seems to be justified. The classification of Kleinert et al. (1981) into five annular and four cruciform pulleys was the most consistent with our results. The constant presence of the mid-phalangeal annular pulleys in zones III and VII shows their major role in preventing the tendons from bow-stringing. The cruciform pulleys seem to allow the tendon sheath to deform during flexion.

Fingers↗