Multi-disciplinary team (MDT) is increasingly applied in oncology and refractory diseases. In recent years, MDT has also been applied in diagnosis and treatment of pituitary adenoma and related diseases. This review summarizes the advantages and characteristics of the MDT diagnosis and treatment mode, and analyzes the application and effect of the MDT diagnosis and treatment mode in the Center of Pituitary Adenoma and Related Diseases, West China Hospital, Sichuan University. So far, it has shown that MDT has advantages such as it is professional, full of collaborative interaction, and efficient and optimized. It is a platform of multi-disciplinary cooperation and resources in the diagnosis and treatment of difficult diseases. Case discussion in MDT mode is conducive to timely selection of the best treatment options for patients with pituitary adenoma and related diseases, providing a good learning platform for doctors with different professional backgrounds, and promoting the improvement of professional diagnosis and treatment level of doctors in related departments. The development of MDT will help us to use limited medical resources efficiently, promote the medical team to be more specialized, optimize the diagnosis and treatment process, and improve the effectiveness of the treatment, for benefiting more patients with pituitary adenomas and related diseases.
目的:研究空蝶鞍综合征(ESS)患者的X线、CT、MRI表现,探讨三种诊断方法在ESS的诊断价值。材料与方法:32例ESS具有完整的X线、CT、MRI及临床资料。结果:X线、CT、MRI均能发现蝶鞍扩大,X线不能分辨鞍内结构;CT可显示垂体萎缩,识别75％的垂体柄,有少量伪影干扰,观察细节受影响;MRI完全显示鞍区解剖结构及信号变化。结果:MRI是ESS的最佳影像学诊断手段。
Objective To investigate the effects and underlying mechanisms of human pituitary tumor-transforming gene 1 (hPTTG1) small interfering RNA (siRNA) on apoptosis of ovarian cancer cell line A2780. Methods hPTTG1 siRNA was transfected into A2780 with lipofectamine (the hPTTG1 siRNA group), and the normal group and the negative control group were set up. Detections were conducted 48 hours after transfection: the interfering efficiency of hPTTG1 mRNA was measured by real-time polymerase chain reaction, the expression of survivin gene and survivin protein was examined by semiquantitative reverse transcriptase-polymerase chain reaction and Western blot, cell apoptosis was detected by DNA fragmentation gel electrophoresis and propidium iodide staining kit, and the activity of caspase-3 was assayed by caspases colorimetric assay kit. Results The expression of hPTTG1 mRNA was expressly inhibited after hPTTG1 siRNA transfection. DNA ladder was observed in the hPTTG1 siRNA group. The apoptotic rate of hPTTG1 siRNA transfection in the hPTTG1 siRNA group was (17.53±2.17)%, higher than those in the normal group and the negative control group [(8.97±1.56)% and (9.64±1.31)%, respectively], with statistically significant differences between them (P<0.05). The expression levels of survivin mRNA and survivin protein were down-regulated. The activity of caspase-3 was raised. Conclusions siRNA targeting hPTTG1 could induce apoptosis of A2780 by inhibition of survivin expression and activation of caspase-3. It may be a potential target for gene therapy of ovarian cancer.
摘要:目的:总结巨大垂体腺瘤水钠代谢紊乱的围手术期处理经验。方法:对71例巨大垂体腺瘤患者术前及术后1周内每日检测血、尿电解质水平,以及血、尿渗透压,判断失钠及失水类型。总结不同瘤体大小与手术入路和水钠紊乱发生率、程度、时间之间的关系。结果:71例巨大垂体腺瘤患者中,出现水钠代谢紊乱52例,发生率73.2%。肿瘤大小与水钠紊乱发生率、严重程度、发生时间成正比,而手术入路选择与水钠代谢紊乱发生无明显相关。结论:巨大垂体腺瘤患者术后水钠代谢紊乱的发生与瘤体大小成正相关,其出现时间和表现形式复杂。对水钠代谢紊乱严重患者可适当予以预防性治疗,以减少临床症状和不良后果。Abstract: Objective: To summarize the preioperative management experience of metabolic disturbance of water and natrium for patients with giant pituitary adenomas. Methods: The electrolyte and osmotic pressure of blood and urine in patients with giant pituitary adenomas were detected within preoperative and postoperative one week and the type of the metabolic disturbance of water and natrium were determined. The correlation of the different tumor size and surgical approach with the incidence rate, extent and time of the metabolic disturbance was summarized. Results: There were 52 cases with different extent metabolic disturbance of water and natrium in 71 cases of giant pituitary adenomas(73.2%). There were a positive correlation of tumor size with the incidence rate, extent and time of the metabolic disturbance, and a negative correlation of surgical approach with that of the metabolic disturbance. Conclusion: The metabolic disturbance of water and natrium in giant pituitary adenomas was positive correlation with the tumor size, which. is various in emergence time and pattern of manifestation. To reduce the clinical symptoms and adverse consequences, prophylactic treatment may be used in patients with serious metabolic disorder of water and natrium.
ObjectiveTo explore the association between paroxetine (Seroxat) and level of blood sugar and endocrine hormones in pre-diabetes patients with anxiety and depression. MethodsFifty-four pre-diabetes patients with anxiety and depression diagnosed from January 2010 to December 2012 were recruited. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess depression and anxiety. All the patients were treated by paroxetine. The glucose tolerance test (OGTT), ACTH and cortisol were tested in patients at baseline and within 24 weeks. ResultsAfter 24 weeks' treatment, the level of anxiety and depression as well as the OGTT 0.5 h (0.5 h PG), OGTT 1 h (1 h PG), OGTT 2 h (2 h PG), glycated hemoglobin (HbA1c), adrenocorticotropic hormone (ACTH) and cortisol were significantly decreased (P<0.05 or P<0.01). The glycated HbA1c had a positive correlation with adrenocorticotropic hormone (ACTH) and cortisol (F). Before and after treatment, the reduced rate of ACTH and reduced rate of cortisol respectively exhibited a positive correlation with the reduced rate of HbA1c, reduced rate of SAS and reduced rate of SDS. ConclusionAnti-anxiety depression treatment can lower blood sugar level in pre-diabetes patients with anxiety and depression significantly, which may be related to the activity of HPA axis.
【摘要】 目的 分析手术治疗垂体瘤患者长期临床恢复以及生活质量改善情况。 方法 回顾性分析2007年12月-2008年9月手术治疗的103例垂体瘤患者术前以及术后长期随访资料，使用SF-36量表对术前、术后患者生活质量进行评估，分析手术治疗前后患者症状、激素水平恢复情况以及生活质量改善情况，并进一步分析肿瘤大小、侵袭程度对术后生活质量的影响。 结果 术后头痛症状消失52例，视力改善76例，其他症状具有不同程度改善；术后SF-36生活质量评估结果显示，患者除精神健康外的7个维度（生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能）均有明显改善（P＜0.05），不同肿瘤大小及侵袭程度的患者术后生活质量评分均无统计学意义（P＞0.05），垂体功能完全恢复者生活质量评分高于垂体功能低下者（P＜0.05）。 结论 显微手术治疗垂体瘤患者可明显改善患者的一般症状、提高患者的生活质量，单纯肿瘤的大小和侵袭程度对术后生活质量的影响程度较小，术后垂体功能的恢复程度明显影响患者的生活质量，垂体瘤术后患者的激素长期替代治疗尚需进一步加强。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.
Objective To study the methods and techniques of the treatment forextensive suprasellar pituitary adenona and repairing hole.Methods From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via Ⅰand Ⅱ space of optic chiasma. The small bone flap was fixed with Ti clamp. Results After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. Conclusion Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.