PitSurgRT: real-time localization of critical anatomical structures in endoscopic pituitary surgery.

PURPOSE: Endoscopic pituitary surgery entails navigating through the nasal cavity and sphenoid sinus to access the sella using an endoscope. This procedure is intricate due to the proximity of crucial anatomical structures (e.g. carotid arteries and optic nerves) to pituitary tumours, and any unintended damage can lead to severe complications including blindness and death. Intraoperative guidance during this surgery could support improved localization of the critical structures leading to reducing the risk of complications. METHODS: A deep learning network PitSurgRT is proposed for real-time localization of critical structures in endoscopic pituitary surgery. The network uses high-resolution net (HRNet) as a backbone with a multi-head for jointly localizing critical anatomical structures while segmenting larger structures simultaneously. Moreover, the trained model is optimized and accelerated by using TensorRT. Finally, the model predictions are shown to neurosurgeons, to test their guidance capabilities. RESULTS: Compared with the state-of-the-art method, our model significantly reduces the mean error in landmark detection of the critical structures from 138.76 to 54.40 pixels in a 1280 × 720-pixel image. Furthermore, the semantic segmentation of the most critical structure, sella, is improved by 4.39% IoU. The inference speed of the accelerated model achieves 298 frames per second with floating-point-16 precision. In the study of 15 neurosurgeons, 88.67% of predictions are considered accurate enough for real-time guidance. CONCLUSION: The results from the quantitative evaluation, real-time acceleration, and neurosurgeon study demonstrate the proposed method is highly promising in providing real-time intraoperative guidance of the critical anatomical structures in endoscopic pituitary surgery.

Morphology and ultrastructure of the hypophysis in bactrian camels ( Camelus bactrianus ) / Morfología y ultraestructura de la hipófisis en camellos bactrianos ( Camelus bactrianus )

The morphology of the hypophysis in Bactrian camel has not been described in the literature, despite it being the master of endocrine organs in vertebrates. In the present study, we examined the morphological features of the hypophysis in Bactrian camel by means of gross anatomy, light and electron microscope. Our findings showed that the gland was a protrusion of the bottom of the hypothalamus at the base of the brain with about 1.54 g in weight and 2 cm3 in volume. The hypophysis consists of two major parts: fully developed adenohypophysis and underdeveloped neurohypophysis, the adenohypophysis consists of pars distalis and pars intermedia. Seven type cells of the pars distalis could be distinguished with immunohistochemical techniques and electron micrographs: somatotroph, mammotroph, thyrotroph, corticotroph, gonadotroph, chromophobe and stellate cells which is in accordance with most mammals. Notably, the stellate cells could be obviously distinguished from chromophobe cells in histological oberservation. Moreover, the corpusculum neurosecretorium (Herring bodies) were rare in the external neurohypophysis, and mainly distributed in the internal neurohypophysis, this was different from most mammals. Results from this study would provide a necessary theoretical basis for ongoing investigations for Bactrian camels and their good adaptability in arid and semi-arid circumstances.

La morfología de la hipófisis en el camello bactriano no ha sido descrita en la literatura, a pesar de ser el maestro de los órganos endocrinos en los vertebrados. En el presente estudio, examinamos las características morfológicas de la hipófisis del camello bactriano por medio de anatomía general, microscocopía de luz y microscopía electrónica. Nuestros hallazgos mostraron que la hipófisis es una protuberancia ubicada en la porción inferior del hipotálamo, en la base del cerebro, con aproximadamente 1,54 g de peso y 2 cm3 de volumen. La hipófisis consta de dos partes principales: adenohipófisis, completamente desarrollada, y neurohipófisis, poco desarrollada; además, la adenohipófisis consta de una pars distalis y una pars intermedia. Con técnicas inmunohistoquímicas y micrografías electrónicas en la pars distalis se pudieron distinguir siete tipos de células: somatotrofas, mamotróficas, tirotrofas, corticotrofas, gonadotrofas, cromófobas y estrelladas, lo que es similar a la mayoría de los mamíferos. En la observación histológica las células estrelladas se pueden distinguir naturalmente de las células cromófobas. Además, es rara la presencia de corpusculum neurosecretorium (Cuerpos de Herring) en la neurohipófisis externa, hallándose distribuidos principalmente en la neurohipófisis interna, esto es diferente a lo encontrado en la mayoría de los mamíferos. Los resultados de este estudio proporcionarían una base teórica necesaria para las investigaciones en curso de los camellos bactrianos y su buena adaptabilidad en circunstancias áridas y semiáridas.

Pituitary gland volumes in patients with obsessive-compulsive disorder before and after cognitive-behavioral therapy

Objective: The beneficial effects of psychopharmacological and cognitive behavioral therapy (CBT) on the brain are not well understood. In a previous study, we found smaller pituitary volumes in patients with obsessive-compulsive disorder (OCD). The purpose of this study was to examine the effect of CBT on pituitary gland volume. Methods: A total of 81 patients with various anxiety disorders and the same number of healthy controls underwent magnetic resonance imaging, and their pituitary gland volumes were compared at baseline. Pituitary gland volumes were also measured before and after CBT in the patient group. Results: OCD patients had smaller pituitary gland volumes at baseline than healthy controls (0.54±0.29 cm3 for OCD patients vs. 0.82±0.30 cm3 for healthy controls; p < 0.001). We found no significant changes in OCD patient pituitary gland volume after the 16-week treatment period, with mean pre- and post-treatment values of 0.54±0.29 cm3 and 0.56±0.32 cm3, respectively (p > 0.05). Conclusion: Our results indicate an absence of post-CBT volumetric changes in the pituitary gland of OCD patients.

Dynamics of ovarian maturation during the reproductive cycle of Metynnis maculatus, a reservoir invasive fish species (Teleostei: Characiformes)

In this study, we evaluated the dynamics of ovarian maturation and the spawning processes during the reproductive cycle of Metynnis maculatus. Adult females (n = 36) were collected bimonthly between April 2010 and March 2011. The mean gonadosomatic index (GSI) was determined, ovarian and blood samples were submitted for morphometric evaluation and the steroid plasma concentration was determined by ELISA. This species demonstrated asynchronous ovarian development with multiple spawns. This study revealed that, although defined as a multiple spawning species, the ovaries of M. maculatus have a pattern of development with a predominance of vitellogenesis between April and August and have an intensification in spawning in September; in October, a drop in the mean GSI values occurred, and the highest frequencies of post-ovulatory follicles (POFs) were observed. We observed a positive correlation between the POF and the levels of 17α-hydroxyprogesterone. Metynnis maculatus has the potential to be used as a source of pituitary tissue for the preparation of crude extracts for hormonal induction; the theoretical period for use is from September to December, but specific studies to determine the feasibility of this approach must be conducted.

Neste estudo, avaliamos a dinâmica da maturação ovariana a desova durante o ciclo reprodutivo de Metynnis maculatus. Fêmeas adultas (n = 36) foram coletadas bimestralmente entre abril de 2010 e março de 2011. O índice gonadossomático (IGS) foi calculado e amostras de ovário e de sangue foram submetidas à avaliação morfométrica e das concentrações plasmáticas dos esteroides por ELISA, respectivamente. A espécie apresenta desenvolvimento ovariano assincrônico, com múltiplas desovas. Neste estudo revelamos que mesmo sendo de desova parcelada, os ovários do M. maculatus mostraram um padrão de desenvolvimento com predomínio de atividade vitelogênica entre abril a agosto e intensificação da desova em setembro. Em outubro houve uma diminuição nos valores médios de IGS, bem como registramos as maiores frequências de folículos pós-ovulatórios (FPOs). Observamos uma correlação positiva entre a frequência de FPOs e a concentração plasmática de 17 α-OHP. O M. maculatus tem potencial para ser usado como fonte para uso de hipófise para preparo de extrato bruto para indução hormonal, sendo o período teórico para coleta de hipófises de setembro a outubro, mas estudos específicos para esta finalidade ainda precisam ser desenvolvidos.

Anatomy and histophysiological changes in pituitary of calotes versicolor during beeding and nnbreeding sasons / Anatomía y cmbios hstofisiológicos en la glándula pituitaria de la calotes versicolor durante las temporadas de crianza y la no reproductiva

Calotes versicolor, collected during peak breeding and nonbreeding season were used for the study of anatomy and histophysiology of pituitary gland. In C. versicolor the pituitary gland is small compact mass attached to the hypothalamus by a delicate stalk. It is of two basic units, adenohypophysis and neurohypophysis. The adenohypophysis includes pars distalis (PD) and pars intermedia (PI). The pars tuberalis (PT) which is usually reduced in reptiles, is absent in C. versicolor. The neurohypophysis is composed of median eminence (MI) and neural lobe or pars nervosa (PN). The anterior PD is rich acidophils than the posterior PD during breeding season. These cells are differentiated as A1 and A2 cells. The A1 cells are erythrosinophilic and stained purple or red and A2 cells stained yellow with orange G. The identified A1 cells are regarded as lactophores and A2 cells are regarded as somatotropes. The secretion of these cells and cell number is reduced during nonbreeding season. The basophils of PD are PAS +, AF + and aniline blue + during breeding season. These cells are classified as B1 and B2 cells depending on their size and location. The large B2 cells are present in cords and B1 cells are located closely to these parts. The B1 and B2 cells are regarded as thyrotrophs and gonadotrophs respectively. During nonbreeding these cells show negative response to the above stain. The PI is large and labulated. The cells are AF+, erythrosine and secrete highly granular material during breeding season. During nonbreeding season they become AF-, erythrosine- and less secretory. The secretion present in neurosecretory cells of the neural lobe appears as large granules and they are AF+. These cells take deep blue stain indicating rich neurosecretory material during both breeding and nonbreeding season. The median eminence (MI) is located at the anterior part of neurohypophysis and sends portal capillaries to adenohypophysis.

Calotes versicolor, recolectadoss durante el peak de la temporada no reproductiva y la reproductiva fueron utilizados para el estudio de la anatomía e histofisiología de la glándula pituitaria. En C. versicolor la glándula pituitaria es una masa compacta y pequeña unida al hipotálamo por un tallo delgado. Se trata de dos unidades básicas, adenohipófisis y neurohipófisis. La adenohipófisis incluye la pars distalis (PD) y la pars intermedia (PI). La pars tuberalis (PT), usualmente reducida en reptiles, está ausente en C. versicolor. La neurohipófisis está compuesta por una eminencia media (EM) y el lóbulo neural o pars nerviosa (PN). La PD anterior es más rica en acidófilos que la PD posterior durante la temporada de reproducción. Estas células se diferencian como células A1 y A2. Las células A1 son eritrosinofílicas y se tiñen de color púrpura o rojo y A2 son teñidas de amarillo con anaranjado G. Las células identificadas A1 se consideran lactóforas y las células A2 se consideran somatotropas. La secreción de estas células y el número de células se reduce durante la temporada no reproductiva. Las basófilas de la PD son PAS+, AF+ y azul anilina + durante la temporada de cría. Estas células se clasifican como las células B1 y B2 en función de su tamaño y ubicación. Las grandes células B2 están presentes en cordones y B1 se encuentran localizadas cerca de estas partes. Las células B2 y B1 se consideran tirotrofos y gonadotrofos respectivamente. Durante la temporada no reproductiva de estas células muestran una respuesta negativa a la tinción anterior. La PI es grande y labulada. Las células son AF+, eritrosina+ y secretan material altamente granular, durante la temporada de cría. Durante la temporada no reproductiva se convierten en AF-, eritrosina- y de menos secreción. La secresión presente en las células neurosecretoras del lóbulo neural aparece en forma de gránulos grandes y es AF+. Estas células toman una profunda tinción azul indicando el rico material..

Hypogonadism after traumatic brain injury: [review] / Hipogonadismo após traumatismo craniano encefálico: [revisão]

Traumatic brain injury (TBI) is the most common cause of death and disability in young adults. Post-TBI neuroendocrine disorders have been increasingly acknowledged in recent years due to their potential contribution to morbidity and, probably, to mortality after trauma. Marked alterations of the hypothalamic-pituitary axis during the post-TBI acute and chronic phases have been reported. Prospective and longitudinal studies have shown that some abnormalities are transitory. On the other hand, there is a high frequency (15 percent to 68 percent) of pituitary hormone deficiency among TBI survivors in a long term setting. Post-TBI hypogonadism is a common finding after cranial trauma, and it is predicted to develop in 16 percent of the survivors in the long term. Post-TBI hypogonadism has been associated with adverse results in the acute and chronic phases after injury. These data reinforce the need for identification of hormonal deficiencies and their proper treatment, in order to optimize patient recovery, improve their life quality, and avoid the negative consequences of non-treated hypogonadism in the long term.

O traumatismo cranioencefálico (TCE) é a causa mais comum de morte e incapacidade em adultos jovens. Desordens neuroendócrinas pós-TCE vêm sendo reconhecidas cada vez mais nos últimos anos devido à sua potencial contribuição para a morbidade e, possivelmente, mortalidade após trauma. Alterações acentuadas do eixo hipotálamo-hipófise foram documentadas nas fases aguda e crônica pós-TCE. Estudos prospectivos e longitudinais têm mostrado que algumas anormalidades são transitórias. Por outro lado, existe uma elevada frequência de deficiências hormonais hipofisárias a longo prazo entre os sobreviventes de TCE, que varia de 15 por cento a 68 por cento. Hipogonadismo pós-TCE é um achado comum a longo prazo e estima-se que, em média, 16 por cento dos sobreviventes sejam afetados. Hipogonadismo pós-TCE tem sido associado a resultados adversos tanto na fase aguda quanto na fase crônica após a lesão. Esses dados reforçam a necessidade da identificação e adequado tratamento das deficiências hormonais, para otimizar a recuperação do paciente, melhorar a qualidade de vida e evitar as consequências negativas a longo prazo do hipogonadismo não tratado.

Histological seasonal changes in ovaries of Spotted tinamous (Nothura maculosa Tinamidae, Temminck, 1815) related to gonadotrope population / Cambios histológicos estacionales en ovarios de perdiz común (Nothura maculosa Tinamidae, Temminck, 1815)) y su relación con la población de gonadotropas

Nothura maculosa is a South American Tinamidae with a marked seasonal reproductive pattern. This work describes ovarian seasonal changes in this species related to gonadotrope (GTHs) population. Ovary and pituitary samples were collected monthly from adult birds during four annual periods. They were fixed in Bouin's solution and processed for light microscopy. The data of post-fixation gonadal weight were analysed using STATISTIX 4.0. Histological sections of the ovaries were stained with H/E, PAS and Goldner-Masson trichrome. Single and double immunostaining were applied on pituitary sections with anti-chicken-FSH and anti-chicken-LH antibodies. The samples were analysed in quarterly periods of the year, Pl: March-May (resting stage); P2: June-August (developing stage); P3: September-November (reproductive stage); P4: December-February (involutive stage). Ovary weight (ow) significantly varied among periods (p<0.001). During Pl, only primordial and previtellogenic follicles were observed, ow 0.09±0.01 g (n=25); during P2, developing follicles with signs of vitellogenesis were detected, ow 0.13+0.01 g (n=14); during P3, maximum follicular development was found, ow 0.9 +/- 0.15 g (n=39); P4 exhibited great variability in follicular stages, ow 0.18+0.18 g (n=19). Involutive atresia was observed in all the periods, while bursting atresia and post-ovulatory follicles were only characterized at P3 and P4. The GTHs containing few LH and FSH immunoreactive (ir) granules were predominant during P1-P2. The GTHs with LH ir granules were abundant in intermediate zone and caudal lobe in P3 and P4 while few cells contained both types of granules. The number of FSH cells was increased during P3 and P4. The histological ovarían changes were narrowly correlated with the variations in the gonadotrope population.

Nothura maculosa es un tinámido sudamericano que presenta marcada estacionalidad reproductiva. Este trabajo describe los cambios estacionales del ovario de esta especie, en relación con la población de gonadotropas (GTHs). Muestras de ovarios y pituitarias de ejemplares adultos fueron colectadas mensualmente durante cuatro años; se fijaron en solución de Bouin y procesadas para M.O. Los datos del peso gonadal posfijación fueron analizados usando STATISTIX 4.0. Los cortes de ovarios fueron coloreados con H/E, P.A.S. y Tricrómico de Goldner-Masson. En cortes de adenohipófisis se aplicó inmunocitoquímica simple y doble (sistema ABC, Vector Lab.), empleando anticuerpos anti-pollo FSH y anti-pollo LH. Las muestras se analizaron en períodos trimestrales de cada año (P): Pl: Marzo-Abril-Mayo (etapa de reposo), P2: Junio-Julio-Agosto (etapa de desarrollo), P3: Septiembre-Octubre-Noviembre (etapa reproductiva), P4: Diciembre-Enero-Febrero (etapa involutiva). El peso de los ovarios (PO) varió significativamente entre los periodos (p< 0.001). Durante Pl, sólo se observaron folículos primordiales y pre-vitelogénicos, PO 0.09 +/- 0.01 g (n=25); durante P2, se detectaron folículos en desarrollo con signos de vitelogénesis, PO 0.13+0.01 g (n=14); durante P3, se encontró máximo desarrollo folicular, PO 0.90+0.15 g (n=39); P4 exhibió gran variabilidad folicular, PO 0.18+0.18 g (n=19). La atresia involutiva se observó en todos los períodos, mientras que la atresia explosiva y los folículos postovulatorios caracterizaron a P3 y P4. Las GTHs conteniendo escasos granulos LH y FSH inmunoreactivos (ir) predominaron durante Pl y P2. Las GTHs con granulos LH¡> eran abundantes en la zona intermedia y en el lóbulo caudal en P3 y P4 mientras que escasas células contenían ambos tipos de granulos. El número de células FSH¡> se incrementó durante P3 y P4. Los cambios histológicos del ovario se correlacionaron estrechamente con las variaciones en la población de gonadotropas.

Study of Sphenoid Sinus Anatomy in Relation to Endoscopic Surgery / Estudio Anatómico del Seno Esfenoidal en Relación con la Cirugía Endoscópica

For radical surgery of the past, the precise definition of the clefts of the paranasal sinuses was of limited significance. In the recent years, the transsphenoidal approach to the pituitary gland has come into practice and the study of the surgical anatomy and relationships of the sphenoid sinus has gained increased significance. To better define this anatomy, 20 sphenoid sinuses in cadavers were dissected to reveal important anatomical relationships, dimensions, volume and pneumatization of the sphenoid sinus. The results of the study are discussed with particular reference to the important surgical anatomical features of the sphenoid sinus. The results also point towards the possibility of racial variations in terms of relationships of the sphenoid sinus to internal carotid artery and optic nerve in the Indian population.

En las cirugías radicales del pasado, la definición precisa de las hendiduras de los senos paranasales fueron de importancia limitada. En los últimos años, el abordaje transesfenoidal de la hipófisis y las relaciones del seno esfenoidal han tenido en la práctica y en el estudio de la anatomía quirúrgica, un significativo incremento. Para definir mejor esta anatomía, 20 senos esfenoidales fueron disecados en cadáveres para revelar importantes relaciones anatómicas, dimensiones, volumen y neumatización del seno esfenoidal. Los resultados de este estudio son discutidos con referencia particular para la anatomía quirúrgica del seno esfenoidal. Los resultados también apuntan hacia la posibilidad de variaciones raciales, en términos de relaciones del seno esfenoidal con la arteria carótida interna y el nervio óptico, en la población de la India.

Alterações da haste hipofisária e suas implicações clínicas / Abnormalities of the pituitary stalk and its clinical implications

O estudo da haste hipofisária através da ressonância magnética (RM) tem possibilitado a identificaçäo de certas alteraçöes de imagem que se correlacionam clinicamente com diversos distúrbios endócrinos. O conhecimento da embriologia e da anatomia da regiäo hipotálamo-hipofisária, assim como a definiçäo dos critérios de normalidade à RM säo fundamentais para uma melhor compreensäo e caracterizaçäo das alteraçöes da haste hipofisária. O espessamento (ou alargamento) é comumente associado ao diabetes insipidus (DI) e o seu achado requer, principalmente em crianças e adolescentes, a pesquisa de uma causa etiológica de base. O afilamento, a interrupçäo abrupta e a ausência da haste hipofisária estäo associados à deficiência congênita de GH, denotando tais achados quadros clínicos por vezes distintos. Por fim, mutaçöes em diferentes fatores de transcriçäo envolvidos na organogênese hipofisária estäo associadas a alteraçöes na RM, tornando-a uma importante ferramenta na investigaçäo do hipopituitarismo de causa genética

Aversive stimulation during the stress-hyporesponsive period does not affect the number of corticotroph cells in neonatal male rats

Immunohistochemistry was used to evaluate the effects of neonatal handling and aversive stimulation during the first 10 days of life on the number of corticotrophs in the anterior lobe of the pituitary of 11-day-old male Wistar rats. Since adult rats handled during infancy respond with reduced corticosterone secretion in response to stressors and with less behavior inhibition in novel environments, we assumed that neonatal stimulation could affect pituitary morphology during this critical period of cell differentiation. Three groups of animals were studied: intact (no manipulation, N=5), handled (N=5) and stimulated (submitted to 3 different aversive stimuli, N=5). The percentage of ACTH-immunoreactive cells in the anterior lobe of the pituitary (number of ACTH-stained cells divided by total number of cells) was determined by examining three slices per pituitary in which a minimum of 200 cells were counted by two independent researchers. Although animals during the neonatal period are less reactive to stress-like stimulation in terms of ACTH and corticosterone secretion, results showed that the relative number of ACTH-stained cells of neonatal handled (0.25 + 0.01) and aversive stimulated (0.29 + 0.03) rats was not significantly different from intact (0.30 + 0.03) animals. Neonatal stimulation may have a differential effect on the various subpopulations of corticotroph cells in the anterior pituitary.

Aspecto morfológico da glândula pituitária do gambá sul-americano Didelphis azarae / Morphologic aspect of the pituitary gland of the south-american opossum Didelphis azarae

Na hipófise do gambá sul-americano Didelphis azarae, o processo infundibular (neuro-hipófise) está envolvido pela adeno-hipófise e separa-se do lúmen hipofisário por uma camada de células pavimentosas que é contínua cocm a adeno-hipófise. A pars tuberalis forma um colar de células em otrno da haste infundibular e é rica em vasos sanguíneos. Na adeno-hipófise agrupamentos de células parenquimatosas estäo envolvidos por uma delicada malha de fibras conjuntivas associada a capilares

Neurología de las alteraciones neuroendocrinas / Neurology of neuroendocrinological disturbances

Se revisan las manifestaciones neurológicas de trastornos hipotalámicos, trastornos hipofisarios y enfermedades neuroendocrinas. Las enfermedades hipotalámicas se caracterizan por problemas de equilibrio hídrico, temperatura corporal, estado del conocimiento, sueño, emociones y comportamientos. Las lesiones hipofisarias producen cefalea, lesión de pares craneales, lesión de vías visuales y atrofia óptica. Las enfermedades neuroendocrinas producen varios trastornos neuromusculares, demencia y alteraciones difusas del sistema nervioso