[Progress in the surgical management of pituitary neoplasms].
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Biomedical subjects
Publications and source records attributed to N Kageyama.
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It has been reported that the plasma growth hormone (GH) and prolactin (PRL) levels in acromegalic patients were suppressed after intensive administration of dopaminergic drugs, but we found that the plasma GH levels in some acromegalic patients were not suppressed. Plasma GH and PRL levels after a single oral administration of CB-154 (2.5mg) and L-DOPA (1g) were measured in 18 active acromegalic patients with and without galactorrhea. 1. The mean plasma GH levels after the administration were clearly suppressed in 8 patients with galactorrhea, while they were not suppressed in 10 patients without galactorrhea. These drugs were more effective in suppressing plasma GH levels in acromegalic patients with galactorrhea and hyperprolactinemia. 2. We calculated the responsiveness of the plasma GH level as follows: GH responsiveness (%) = (mean plasma GH level after the administration of CB-154 or L-DOPA)/ (basal GH level) x 100. The basal plasma PRL levels were inversely correlated with GH responsiveness (CB-154: r=-0.690, p less than 0.01. L-DOPA: r=-0.541, p less than 0.05). It was found that the effect of dopaminergic drugs on plasma GH levels was closely correlated with basal PRL levels in acromegalic patients. This implies that the chronic administration of CB-154 may be effective in acromegalic patients with galactorrhea and hyperprolactinemia.
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Computed tomography of the cervical spine has been carried out on 21 patients with the ossification of the posterior longitudinal ligament. There was a correlation between the shape and the extent of ossification and the type of myelopathy. Computed tomography is important for operative intervention.
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A case of spontaneous hematomyelia was reported with a review of the literature. A 39-year-old woman, with sudden onset of pain in her left neck and arm 13 days previously, presented with a progressive flaccid tetraplegia below C5, dissociated sensory loss from C7 through Th4 dermatome and a minimal deep sensory loss in her right leg. Myelography revealed a symmetrical enlargement of the spinal cord at the leve of C5, C6 and C7. Laminectomy was performed and intramedullary blood clot, which was located in the region of C6 and C7, was evacuated. However, there were no vascular anomalies not only in macroscopic findings but also in histological examination. The postoperative course was uneventful and the patient gradually improved in her motility. At 5 month' follow-up examination she continued to do well with a minimal sensory loss of all modalities below the level of C7. Report of 16 patients with spontaneous hematomyelia including our case have been reviewed. Incidence of spontaneous hematomyelia without vascular anomalies or hemorrhagic diathesis very rare, being found in only 4 cases. In cases with good outcome the intramedullary hematoma was found to be located below the lower cervical region and limited within 2 spinal segments in its extent. Good postoperative results were obtained in 5 out of 7 patients who received surgical intervention, suggesting an essential importance of early diagnosis and surgery.
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