Surgical Management of Giant Pituitary Adenomas

OBJECTIVE: Giant pituitary adenomas are rare. The location of these adenomas are close to vital neural and vascular structures with widespread extensions that makes the radical surgical management difficult. METHODS: From October 1994 to August 1998, we experienced 20 patients with giant pituitary adenomas out of 178 surgically treated pituitary adenoma patients. Giant pituitary adenoma was diagnosed on the basis of the longest diameter of being more than 4cm in MRI scan. We reviewed the clinical presentation, types of tumor, size and degree of suprasellar or parasellar extension, routes of surgical approach, postoperative surgical outcomes and complications. RESULTS: The incidence of giant pituitary adenomas was 11%. The most common chief complaint was visual disturbance(n=16). The non-functioning adenoms(n=16) were the majority and the other 4 patients were functioning adenomas(prolactinoma n=2, acromegaly n=1, cushing's disease n=1). The patients underwent transsphenoidal approach(TSA)(n=15) or transcranial approach(TCA)(n=5). Gross total or subtotal removal were achieved in 60% of TSA group(9 of 15) and 40% of TCA group(2 of 5). Postoperative complications were in 6 patients with TSA; cerebrospinal fluid(CSF) leakages(n=2), postoperative bleeding(n=2), transient diabetes insipidus(DI)(n=2). Visual function was improved in 69%(9 of 13) after TSA and 40% after TCA. Surgical results in the TSA group were better than those in transcranial approach group, and there were fewer and less severe postoperative complications. CONCLUSION: Even in the giant pituitary adenomas, conventional transsphenoidal approach was effective as the initial treatment modality in terms of effective decompression, functional recovery, and low morbidity.

Decision-making process and satisfaction of pregnant women for delivery method / 예방의학회지

This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband(0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand(12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9%. However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.

A Study of the Relationship of Preeclampsia with Total Plasma Fibronectin / 대한산부인과학회잡지

Of 119 full-term pregnant subjects studied from October, 1995 to March, 1996, 79 hadpreeclampsia(severe; 43, mild; 36) and 40 were normotensive controls. The plasma fibronectinlevels of each subject were assayed by turbidometric immunoassy(Boehringer Mannheim).The objective of this study was to evaluate the relationship of plasma fibronectin withpreeclampsia as a marker for vascular injury.The results were as follows:1. There were significant differences of plasma fibronectin values among the normotensivepregnancy, mild preeclampsia and severe preeclampsia. Within each group of patients,plasm a fibronectin values were 101.7 +/- 59.4 ng/ml and 249.7 +/- 96.3 ng/ml and 329.2 +/- 169.5 ng/ml, respectively (p < 0.001).2. Plasma fibronectin values had positive correlations with severity of preeclampsia,proteinuria, diastlic blood pressure and systolic blood pressure, but negative correlationswith birth weight and platelet count(p < 0.001).3. When the severity of proteinuria on preeclampsia were +1, +2, and +3 or more,plasma fibr onectin values revealed 246.0 +/- 93.3 ng/ml, 342.3 +/- 185.1 ng/ml and 345.0 +/- 168.1ng/ml, respectively and there were significant differences among three groups.4. To verify the variables correlated with plasma fibronectin by using mutiple regressionanalysis, the only variable which was selected significantly was the severity of preeclampsia(r(2) : 0.529).5. With receiver operating characteristic(ROC) curve analysis of the relationship betweenplasma fibronectin values and preeclampsia, if cut off value was selected at the levelof 175ng/ml or more, the sensitivity for diagnosis of preeclampsia was 87.3%, specificity90.0%, positive predictive value 94.5%, and negative predictive value 78.3%, respectively.

A Clinical and Statistical Study in 78 Cases of Ovarian Cancer / 대한부인종양콜포스코피학회잡지

Clinical and pathological studies were carried out on 78 patients of ovarian cancer from January 1985 to March 1991. The results are as follows : l. Among 78 patients of ovarian cancer, the age group from 51 to 60 years old was most common which was 18 cases(23.1%). 2. When classified according to the cell type, epithelial cell origin cancers were 59 cases (75.6%), ovarian cancers from germ cell origin 9 cases(11.5%), sex cord stromal cancers 3 cases(3.8%), and metastatic cancers 7 cases(8.9%) respectively. 3. When classified according to the FIGO staging, stage I were 34 cases(43.5%), stage II 8 cases(10.3%), stage III 23 cases(29.5%) and stage IV 13 cases(16,7%), respectively. 4. Preoperative mean CA 125 value of stage I ovarian cancer was 130.2+/-57.3U/ml, stage II 74.2+/-144.4U/ml, stage III 376.9+/-296.8U/ml and stage IV 433.9+/-148.2U/ml respectively. and Also preoperative mean CEA value of stage I ovarian cancer was 3.4+/-3.2ng/ ml, stage II 6.9+/-4.3ng/ml, stage III 4.7+/-4.4ng/ml and stage IV 4.6+/-6.3ng/ml respectively. 5. When classified according to the physical examination, the most common finding was palpable mass which were 38 cases(43.7%), the second, abdominal pain 30 cases(38.4%) and the third, abdominal distension 21 cases(26.9%) 6. When classified according to the operation, ipsilateral oophorectomy was 15 cases(25.5%), ipsilateral oophorectomy and contralateral ovary wedge resection 6 cases(10.2%), total abdominal hysterectomy 17 cases(28.8%), total abdominal hysterctomy and omentectomy 14 cases(23.7%), total abdominal hysterectomy and omentectomy and debulking tumor resetion 4 cases(6.7%) and biopsy only 3 cases(5.1%) respetctively. 7. When calssifide according to the postoterative endometrial finding, atrophic pattern was 28 cases(65.7%), proliferative pattern 10 cases(28.6%) and secretory pattern 2 cases(5.7%) respectively.

Response and Toxicity of Chemotherapy in 78Cases of Malignant Ovarian Tumors / 대한부인종양콜포스코피학회잡지

For evaluation of the response and toxicity of the combination chemotherapy, forty six patients with malignant ovarian tumors who had prior surgery were treated with combination chemotherapy from January 1985 to March 1991 at the Department of Obstetrics and Gynecology, Kyung-pook National University Hospital. The results were as follows : 1. The responses were in complete 20 cases(43.5%), in partial 9 cases(19,6%), in stable 6 cases(13.0%), in progressive 11 cases(23.9%) among 46 patients. 2. By the response rates of various combination chemotherapy regimens, the response rate of CAP was 64%(16/25), CP 57.1%(8/14), VAC 100%(3/3), VBP 50%(1/2), FAM 0%(0/1), and Melphalan 100%(1/1) respectively. 3. As the chemotoxicities of combination chemotherapy, leukopenia 20 cases(46.5%), thrombocytopenia 2 cases(4.7%), anemia 20 cases(46.5%), nephrotoxity 6 cases(14.6%), hepatotoxicity 7 cases(18.4%) were observed.

Effects of Intravenous Administration of Nimodipine on Cerebral Pial Vessels after Experimental Subarachnoid Hemorrhage in Rabbits

No abstract available.

A Case of Oligodendroglioma in the Lateral and Third Ventricles

Oligodendroglioma that occurs in the ventricle has been reported uncommonly. The case is reported of a 38-year-old man who presented with severe headache and vomiting and was discovered to have an oligodendroglioma in the lateral and third ventricles. The clinical presentation, radiological finding, pathology and response to radiation are described with brief review of general biology in oligodendroglioma.

The efficacy of tumor markers SCC Ag, CEA and CA-125 in patients with cervical cancer / 대한산부인과학회잡지

No abstract available.