[Results of neuro-endoscopic pituitary surgery in 26 patients with pituitary adenoma]

Endoscopic surgery of pituitary adenoma is a rapidly developing surgical procedure in the field of neurosurgery, with known limitations and advantages. The aim of this study was to evaluate the results of this technique for treatment of a group of patients with pituitary adenoma. In the present study, 26 patients with the diagnosis of pituitary adenoma, who were considered for endoscopic operation between 2002-2005 in Sina and Amir Alam hospitals, were included. The following data were registered: age, sex, symptoms of disease, findings of neurological exam, adenoma type [functional versus non-functional], treatment outcome and complications of the procedure and duration of hospital stay. Twenty six patients [14 male and 11 female] included in the study. Most of them were in the 3-6 decades of life. They included 11 non-functional adenoma, 9 GH-producing adenomas, 3 ACTH secreting adenomas and 3 cases with prolactinomas. Seven patients had complications of the operation [reversible in 6 patients and fatal in 1] and 6 of them had recurrence of the tumor during the 2-year follow up. Endoscopic surgery is an invaluable method for treatment of pituitary adenoma, and factors such as decreased complications and duration of hospital stay further adds to its popularity

Assessment of inter-and intra-observer variability of the la classification for gerd

Los Angeles classification is widely adopted as a means of unifying endoscopic observation for GERD. We assessed the inter- and intra-observer variability of LA classification. Two-hundred fifty-four still images of the lower esophagus taken by an expert endoscopist [RM] were randomly selected and presented to 9 gastroenterologists [2 females, 6 experts, 3 trainees]. They were asked to report the images according to LA classification. After 2 weeks the images were re-ordered and the same people were asked to report them again. Kappa-statistics was calculated for intra- and inter-observer variability. Mean kappa for intra-observer agreement was 0.54 for experts and 0.55 for trainees [p = NS]. Mean intra-observer kappa was greater among females than males [0.70 vs 0.50 respectively, p=0.05]. Mean inter-observer kappa was 0.20 and 0.31 for experts and trainees respectively [p = NS]. Mean inter-observer weighted kappas were 0.25 and 0.07 [p = 0.007] for males and females respectively. Analyzing data for source of the discrepancy showed that the least reproducible reading was GERD-A both for intra- and inter-observer agreement calculations. According to our data, the LA classification, although a major advance in reporting GERD, has a poor to fair reproducibility. There was no difference between experts and trainees in using the LA classification. Females seem to be more consistent in their readings, but have less agreement with others. Despite the inherent short-comings of kappa statistics and the limitation caused by the possible quality of the still images, revision of the LA system seems to be advisable