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Maili moxibustion can alleviate cancer pain, reduce bone marrow suppression, alleviate gastrointestinal reaction of chemotherapeutic drugs, alleviate cancer-related fatigue, inhibit neurotoxic reaction, improve quality of life and prolong patients' survival. It plays therapeutic effects by regulating immunity, inhibiting tumor cell proliferation and regulating tumor microenvironment. The researches of Maili moxibustion for tumor focus on reducing the toxic or side effects of radiotherapy or chemotherapy. In the future, we should continue to study the combination of Maili moxibustion and other therapies on the treatment of tumor.
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OBJECTIVE: To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor. METHODS: We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated. RESULTS: A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery. CONCLUSION: Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.
Subject(s)
Humans , Blood Glucose , Follow-Up Studies , Glucose , Growth Hormone , Heart Ventricles , Mortality , Pituitary Neoplasms , Retrospective Studies , SomatostatinABSTRACT
The data of 30 patients simulated before surgery were analyzed using Dextroscope operation planning system in Department of Neuresurgery,General Hospital of Chinese PLA between August 2004 and September 2005,including 2 patients with basilar artery aneurysm,1 with posterior cerebral artery aneurysm,3 with ophthalmic aneurysm,2 with middle cerebral artery aneurysms,1 with anterior cerebral artery aneurysm,7 atlas-occipital malformation,4 meningioma,5 schwannomas,and 5 deep gliomas. The primary CT and MRI data of 30 patients were input to the workstation of Dextroscope system for 3D reconstruction,reunion,segmentation and simulation the entire process of the operation. The relationship of the cranial nerves,vessels and skull base bone with lesions during operations were similar with that of the preoperative simulation on the workstation. The time of clipping aneurysms was reduced from (37.60±13.43) minutes to (23.51±7.62) minutes following application of Dextroscope system,and time of resections of odontoid processes was shortened from 81 minutes to 50 minutes. The ratios of complications were decreased and the patients' Karnofsky scales were 88.7 scores 3 months after operation. Dextroscope operation planning system can help doctors to analyze the patients' image data on a 3-D view and video outlook. The system can raise a precise and detailed operation plan before operation based on the simulation of the operation process,to well know the difficulty and shorten operation duration.
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BACKGROUND: The anatomical position of facial nerve is often abnormal because of the acoustical neuroma growth, so sometimes, the facial nerve injury is inevitable in the surgery treatment for acoustic neuroma.OBJECTIVE: To investigate the technology, veracity and practicality as well as the relationship between intraoperative monitorning and prognosis of facial nerve, and the clinical experiment was summed up of facial nerve function monitoring in 120 cases of acoustic neuroma surgery.DESIGN: Self-control observation.SETTING: Department of Neurosurgery, General Hospital of Chinese PLA.PARTICIPANTS: Totally 120 patients with acoustic neuroma who received treatment in the Department of Neurosurgery, General Hospital of Chinese PLA from May 1996 to February 2000 were recruited. Among them, 3 cases suffered from small-type acoustic neuroma (＜ 2 cm in diameter), 9 cases from middle-type acoustic neuroma (＞ 2 cm in diameter) and 108 from large-type acoustic neuroma (＞ 3 cm in diameter), including 1 case of bilateral acoustic neuroma and 1 cases of recrudescent acoustic neuroma; Suboccipital retromastoid approach was used in 119 cases and transretrolabyrinthine approach in 1 case.METHODS: American Viking-Ⅳ type monitor was used to monitor facial nervous function. When facial nervous function was monitored, recording electrode was put on orbicular muscle of eye, orbicular muscle of mouth or quadrate muscle of upper lip. When trigeminal motor branch was monitored, recording electrode was put on masseter muscle; When accessory nerve was monitored, recording electrode was put on trapezius muscle.Measurement of evoked auditory brainstem potential: recording electrode was positive electrode and was put at the midline in the frontal region (electroencephalogram 10-20 classification system). The recorded waveshape presented upward deflection. Reference electrode A1 or A2 and ground electrode were put in the midline of frontal pole (relevant to root of nose); Recording electrodes were all needle electrodes and were fixed with adhesive tape. Common stimulus intensity was 80 to 90 nHL, and 40 nHL noise was used in contralateral ear. Facial nerve was reserved following intraoperative monitoring. CT (enhancement scanning was necessary) or MRI was rechecked after operation to investigate the cutting degree of tumor; Facial nerve function was evaluated by H-B scoring (at 2 weeks, or 6 to 9 months following operation).MAIN OUTCOME MEASURES: Facial nerve function by H-B scoring before and after acoustic neuroma surgery.RESULTS: Totally 120 patients were enrolled, and no one dropped out.① Facial nerve anatomy was reserved in 117 cases; One case was failure to reserve facial nerve anatomy because pinnate facial nerve lay behind of acoustic neuroma, and electrical stimulation was not given at the beginning of neuroma resecting, then he received anastomosis of hypoglossal and facial nerve. Nerve of 2 cases was pulled and broken carelessly, and its two stumps were long enough that end-to-end anastomosis of facial nerve was performed with 7-0 absorbable suture following trimming. H-B score was Ⅳ to Ⅴ in the 6th month after surgery. ②Grade Ⅰ of facial nervous function at postoperative 2 weeks was found in 10 cases, grade Ⅱ in 57 cases,grade Ⅲ in 44 eases, grade Ⅳ in 4 cases, grade Ⅴ in 2 cases and gradeⅥ in 3 cases. ③Grade Ⅰ of facial nervous function at postoperative 9 weeks was found in 94 cases, grade Ⅱ in 18 cases, grade Ⅲ in 4 cases,grade Ⅳ in 1 case and grade Ⅵ in 2 cases.CONCLUSION: Spontaneous and evoked facial muscle electromyogram may be helpful to make sure the facial nervous position exactly and estimate the prognosis of facial nerve.
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<p><b>OBJECTIVE</b>To explore the mechanism and strategies of prevention and treatment of vision deterioration after transsphenoidal surgery for removal of pituitary adenoma.</p><p><b>METHODS</b>From January 1980 to February 2001, 1 412 patients were operated on by transsphenoidal surgery to remove pituitary adenoma. Fourteen patients experienced vision deterioration after operation. Clinical data from the 14 patients with vision deterioration were analyzed retrospectively.</p><p><b>RESULTS</b>In this group, the incidence of vision deterioration was 0.99%. Over packing of the adenoma bed was seen in 5 patients, apoplexy of residual tumor in 3, high intracranial pressure in 2, vascular spasm in 2, injury of the optic nerve in the cannel in 1 and unknown reason in 1.</p><p><b>CONCLUSIONS</b>Vision deterioration is a severe complication after transsphenoidal surgery. Early diagnosis and treatment can greatly improve the vision.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenoma , General Surgery , Ischemia , Optic Nerve , Optic Nerve Injuries , Pituitary Neoplasms , General Surgery , Postoperative Complications , Retrospective Studies , Sphenoid Sinus , Vision DisordersABSTRACT
94 cases of pituitary adenomas were examined with radio immunoassay, immunohis-tochemical technique and electron microscopy. Among them, 36 cases associated with hypersomato-tropinemia and hyperprolactinemia were studied. The results showed that they could be classified into four types: (1) mixed growth hormone and prolactin cell adenomas; (2) acidophil stem cell adenomas; (3) plurihormonal adenomas; and (4) growth hormone adenmoas. The pathological and clinical characteristics were discussed.