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1.
Endocr Relat Cancer ; 24(4): C5-C8, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28264912

RESUMO

The classification of neoplasms of adenohypophysial cells is misleading because of the simplistic distinction between adenoma and carcinoma, based solely on metastatic spread and the poor reproducibility and predictive value of the definition of atypical adenomas based on the detection of mitoses or expression of Ki-67 or p53. In addition, the current classification of neoplasms of the anterior pituitary does not accurately reflect the clinical spectrum of behavior. Invasion and regrowth of proliferative lesions and persistence of hormone hypersecretion cause significant morbidity and mortality. We propose a new terminology, pituitary neuroendocrine tumor (PitNET), which is consistent with that used for other neuroendocrine neoplasms and which recognizes the highly variable impact of these tumors on patients.


Assuntos
Adenoma/classificação , Tumores Neuroendócrinos/classificação , Neoplasias Hipofisárias/classificação , Humanos
2.
J Clin Neurosci ; 13(4): 413-8, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16678718

RESUMO

The anaesthetic care of patients undergoing pituitary surgery involves an understanding of the varied presentations of pituitary disease and their implications for the patient's perioperative condition and management. The neuroanaesthetist must also have an appreciation of the issues relevant to the surgical approach (either transsphenoidal or, less commonly, transcranial) and be able to anticipate and manage them accordingly.


Assuntos
Anestesia , Procedimentos Neurocirúrgicos/métodos , Hipófise/efeitos dos fármacos , Hipófise/cirurgia , Humanos , Salas Cirúrgicas/métodos , Doenças da Hipófise/cirurgia
4.
Pain ; 84(2-3): 431-7, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10666551

RESUMO

There is growing evidence to support the use of motor cortex stimulation (MCS) in the management of patients with chronic neuropathic pain. A prospective audit of ten patients using a modified staged technique for motor cortex implantation provides further evidence for the analgesic effectiveness of this technique. Ten patients suffering from phantom limb pain (n=3), post stroke pain (n=5), post traumatic neuralgia secondary to gunshot injury to the brain stem (n=1) and brachyalgia secondary to neuro-fibromatosis (n=150% pain relief) and long-term benefit in 4/5 of patients who initially responded to intermittent cortical stimulation (longest follow up 31 months after implantation). Of those patients who benefited two had post stroke pain, two phantom limb pain and one post-traumatic neuralgia. We conclude that motor cortex stimulation is an effective analgesic intervention in some patients with chronic neuropathic pain, but it is difficult if not impossible to predict those patients who may respond to treatment prior to implantation. Randomised controlled trials are now urgently needed to test the effectiveness of motor cortex stimulation under double-blind conditions.


Assuntos
Terapia por Estimulação Elétrica , Córtex Motor/fisiopatologia , Doenças do Sistema Nervoso/complicações , Dor Intratável/etiologia , Dor Intratável/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Intratável/cirurgia , Cuidados Paliativos/métodos , Estudos Prospectivos
5.
Eur J Paediatr Neurol ; 4(3): 125-9, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10872108

RESUMO

A case is reported describing a complication of an unsuccessful attempt to aspirate the reservoir of a ventriculoperitoneal shunt system with a suspected shunt infection. This arose due to a misunderstanding of the anatomy of the shunt and resulted in an intracerebral haematoma. The complications of cerebrospinal fluid shunting and the difficulty in the diagnosis thereof are outlined. We discuss the role and method of shunt tapping in diagnosing shunt problems before reviewing the literature describing the rationale. The variation in shunt design is emphasized. Guidelines are then proposed not to dissuade physicians from tapping shunts but to ensure that the procedure is performed safely and in collaboration with neurosurgical units.


Assuntos
Líquido Cefalorraquidiano , Hidrocefalia/complicações , Hemorragias Intracranianas/etiologia , Convulsões/etiologia , Sucção/efeitos adversos , Derivação Ventriculoperitoneal , Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/diagnóstico , Diagnóstico Diferencial , Técnicas de Diagnóstico por Cirurgia/efeitos adversos , Humanos , Lactente , Masculino , Erros Médicos , Infecções Respiratórias/sangue , Infecções Respiratórias/diagnóstico , Sucção/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/instrumentação
7.
J Neurosurg ; 95(6): 1110-2, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11765834
10.
Intern Med J ; 34(5): 270-8, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15151674

RESUMO

Solid tumour brain metastases are a frequent clinical dilemma for oncologists and general physicians. The sound management of brain metastases requires a multidisciplinary approach. In this review we discuss the diagnosis and management of brain metastases including the role of surgery, radiotherapy, and chemotherapy. The standard approaches of surgical excision and primary radiotherapy have evolved from randomised studies. However, controversies remain regarding post-surgery irradiation in the setting of a solitary metastasis and the role of palliative chemotherapy.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Quimioterapia Adjuvante , Humanos , Procedimentos Neurocirúrgicos/métodos , Cuidados Paliativos/métodos , Complicações Pós-Operatórias , Radioterapia Adjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
11.
Br J Neurosurg ; 16(3): 290-3, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12201400

RESUMO

The incidence of haemorrhagic complications of intracranial pressure monitoring (ICPM) has previously been reported. However, in these studies, the techniques employed to access the inside of the cranium varied. While 3-mm essentially blind 'twistdrill' craniostomies have been used, their role has been limited for fear of haemorrhagic sequelae. This has also restricted their use in clinical applications other than ICPM. We conducted a prospective observational study looking at haemorrhagic complications of the twistdrill in order to determine its safety and whether it has a role in other clinical settings. Over the period January 1994-February 2001, 941 patients had 1032 twistdrill procedures. There were 550 (58.4%) male patients and 391 (41.6%) female. The age range was 3 months to 93 years (median age 35 years). Only four procedures (0.38%) caused clinically significant bleeds attributable to the twistdrill --all of which were managed conservatively without requiring surgical evacuation. We conclude that twistdrill craniostomies are safe and that their use could be extended to other neurosurgical procedures and potentially to ICPM in non-neurosurgical centres.


Assuntos
Craniotomia/efeitos adversos , Instrumentos Cirúrgicos/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Craniotomia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Lactente , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia
12.
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