In vivo pilot study into superficial microcirculatory characteristics of colorectal adenomas using novel high-resolution magnifying endoscopy with blue laser imaging

BACKGROUND No studies have yet been conducted on changes in microcirculatory hemody-namics of colorectal adenomas in vivo under endoscopy.The microcirculation of the colorectal adenoma could be observed in vivo by a novel high-resolution magnification endoscopy with blue laser imaging(BLI),thus providing a new insight into the microcirculation of early colon tumors.AIM To observe the superficial microcirculation of colorectal adenomas using the novel magnifying colonoscope with BLI and quantitatively analyzed the changes in hemodynamic parameters.METHODS From October 2019 to January 2020,11 patients were screened for colon adenomas with the novel high-resolution magnification endoscope with BLI.Video images were recorded and processed with Adobe Premiere,Adobe Photoshop and Image-pro Plus software.Four microcirculation parameters:Microcirculation vessel density(MVD),mean vessel width(MVW)with width standard deviation(WSD),and blood flow velocity(BFV),were calculated for adenomas and the surrounding normal mucosa.RESULTS A total of 16 adenomas were identified.Compared with the normal surrounding mucosa,the superficial vessel density in the adenomas was decreased(MVD:0.95±0.18 vs 1.17±0.28μm/μm2,P<0.05).MVW(5.11±1.19 vs 4.16±0.76μm,P<0.05)and WSD(11.94±3.44 vs 9.04±3.74,P<0.05)were both increased.BFV slowed in the adenomas(709.74±213.28 vs 1256.51±383.31μm/s,P<0.05).CONCLUSION The novel high-resolution magnification endoscope with BLI can be used for in vivo study of adenoma superficial microcirculation.Superficial vessel density was decreased,more irregular,with slower blood flow.

Clinicopathological features and expression of regulatory mechanism of the Wnt signaling pathway in colorectal sessile serrated adenomas/polyps with different syndrome types

BACKGROUND Colorectal cancer(CRC)is the third most common cancer worldwide,with the fourth highest mortality among all cancers.Reportedly,in addition to adenomas,serrated polyps,which account for 15%-30%of CRCs,can also develop into CRCs through the serrated pathway.Sessile serrated adenomas/polyps(SSAs/Ps),a type of serrated polyps,are easily misdiagnosed during endoscopy.AIM To observe the difference in the Wnt signaling pathway expression in SSAs/Ps patients with different syndrome types.METHODS From January 2021 to December 2021,patients with SSAs/Ps were recruited from the Endoscopy Room of Shanghai Traditional Chinese Medicine-Integrated Hospital,affiliated with Shanghai University of Traditional Chinese Medicine.Thirty cases each of large intestine damp-heat(Da-Chang-Shi-Re,DCSR)syndrome and spleen-stomach weakness(Pi-Wei-Xu-Ruo)syndrome were reported.Baseline comparison of the general data,typical tongue coating,colonoscopy findings,and hematoxylin and eosin findings was performed in each group.The expression of the Wnt pathway-related proteins,namelyβ-catenin,adenomatous polyposis coli,and mutated in colorectal cancer,were analyzed using immunohistochemistry.RESULTS Significant differences were observed with respect to the SSAs/Ps size between the two groups of patients with different syndrome types(P=0.001).The other aspects did not differ between the two groups.The Wnt signaling pathway was activated in patients with SSAs/Ps belonging to both groups,which was manifested asβ-catenin protein translocation into the nucleus.However,SSAs/Ps patients with DCSR syndrome had more nucleation,higherβ-catenin expression,and negative regulatory factor(adenomatous polyposis coli and mutated in colorectal cancer)expression(P<0.0001)than SSA/P patients with Pi-Wei-Xu-Ruo syndrome.In addition,the SSA/P size was linearly correlated with the related protein expression.CONCLUSION Patients with DCSR syndrome had a more obvious Wnt signaling pathway activation and a higher risk of carcinogenesis.A high-quality colonoscopic diagnosis was essential.The thorough assessment of clinical diseases can be improved by combining the diseases of Western medicine with the syndromes of traditional Chinese medicine.

Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

Due to the high risk of morbidity and mortality associated with surgical resection in this tract,endoscopic resection(ER)has taken the place of surgical resection as the first line treatment for non-ampullary duodenal adenomas.However,due to the anatomical characteristics of this area,which enhance the risk of post-ER problems,ER in the duodenum is particularly difficult.Due to a lack of data,no ER technique for superficial non-ampullary duodenal epithelial tumours(SNADETs)has yet been backed by strong,high-quality evidence;yet,traditional hot snare-based techniques are still regarded as the standard treatment.Despite having a favourable efficiency profile,adverse events during duodenal hot snare polypectomy(HSP)and hot endoscopic mucosal resection,such as delayed bleeding and perforation,have been reported to be frequent.These events are primarily caused by electrocautery-induced damage.Thus,ER techniques with a better safety profile are needed to overcome these shortcomings.Cold snare polypectomy,which has already been shown as a safer,equally effective pro-cedure compared to HSP for treatment of small colorectal polyps,is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal adenomas.The aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

Prolactin Adenomas in Senegal: Epidemiological, Diagnostic and Therapeutic Aspects of 89 Cases

Introduction: In Senegal, there is very little data on prolactinomas despite their negative impact on couples fertility. Patients and methods: This was a multicentre, retrospective, descriptive, analytical study conducted from 1 January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals and the endocrinology department of the Abass Ndao Hospital. Results: We included 89 patients, representing a prevalence of 36.7% among all cases of pituitary adenoma. The mean age was 35.6 ± 10 years and the sex ratio was 0.34. The mean time to consultation was 27.1 ± 29 months. Clinical symptoms were dominated by gonadotropic disorders represented by galactorrhoea (71 cases, 79.8%), amenorrhoea (61 cases, 68.5%), and infertility in the couple (31 cases, 34.8%). Fifty-seven (58) patients presented with a tumour syndrome (65.2%, including 57 cases of headache (64%), 34 cases of visual disorders (38.2%) and 8 patients with a dysmorphic syndrome (8.9%). Imaging revealed a macroadenoma in 68.5% (61 cases) and extension of the adenoma in 11 patients (12.4%). The hormonal profile was isolated lactotropic hypersecretion (80 cases, 89.9%) and mixed in 9 cases (including concomitant secretion of GH in 8 cases and ACTH in 1 case). All patients had initially benefited? from dopaminergic agonist-based medical treatment. Pituitary surgery was effective in 45 patients (50.6%), including 44 cases by transsphenoidal approach. Postoperative incidents included transient diabetes insipidus (77.7%) and cerebrospinal fluid leakage (20%). We noted 7 cases (7.9%) of death presenting with a tumour syndrome (100%), a macro-adenoma (85.7%), having undergone pituitary surgery (42.9%). The factors significantly associated with prolactinoma were young age (p Conclusion: This series also demonstrates the impact of prolactin adenomas on reproductive function. Delayed diagnosis explains the predominance of macroadenomas, which are a source of pre- and post-operative complications.

Profile of Pituitary Adenomas in Senegal: Epidemiological, Clinical and Therapeutic Aspects about 241 Collected Cases

Introduction: in adults, adenomas are the most frequent causes of pituitary tumours. The objective was to characterize its epidemiological and clinical aspects, as well as its therapeutic modalities in Senegal. Methodology: this was a multicenter, retrospective, descriptive and analytical study carried out from the Senegalese register of pituitary adenomas (2008-2022). Results: 242 patients were collected with an average age of 42.4 ± 13 years and a sex ratio (M/F) of 0.91. The mean consultation time was 19.7 ± 23 months. The circumstances of discovery were pituitary apoplexy (11 cases, 4.54%), tumor syndrome (176 cases, 72.72%), gonadal manifestations (103 cases, 42.56%), dysmorphic syndrome (21 cases, 8.68%), hypercorticism (15 cases, 6.19%). Morphologically, it was a macroadenoma (197 cases, 81.40%), an extensive adenoma (22 cases, 9.10%). The hormonal profile was lactotropic hypersecretion (80 cases, 33.05%), somatotropic (13 cases, 5.39%), corticotropic (14 cases, 5.78%), mixed (9 cases, 3.71%). The factors significantly associated with prolactinoma were young age (p = 0.000), female sex (p = 0.000), long consultation delay (p = 0.000) and microadenoma (p = 0.001). Only arterial hypertension was associated with acromegaly (p = 0.000). We found a significant correlation between Cushing’s disease and microadenomas (p = 0.000). Non-secreting adenomas were significantly associated with advanced age (p = 0.000), long delay in consultation (p = 0.000), male gender (p = 0.000), tumor syndrome (p = 0.001) and macroadenomas (p = 0.000). Pituitary surgery was effective in 173 patients (71.49%) including 166 cases (68.59%) by transphenoidal approach. Postoperative incidents were transient diabetes insipidus in 82 cases (47.39%), cerebrospinal fluid leak (20 cases, 11.56%). Death was observed in 18 patients in the entire series (7.44%). The latter had a tumor syndrome (88.88%), a macroadenoma (83.33%) and had undergone pituitary surgery (72.22%). Conclusion: pituitary pathology has become a reality with clinical and secretory polymorphism. The diagnostic delay explains the predominance of macroadenomas which are sources of pre and post-operative complications.

Smoking Is a Risk Factor of Colorectal Advanced Adenomas Compared to Nonadvanced Adenomas

Background: It is uncertain that whether smoking is a risk factor of colorectal advanced adenomas compared to nonadvanced adenomas, so we peformed the case-control study to explore this issue. Material and Methods: The cases were defined as patients with advanced adenomas and the controls were patients with nonadvanced adenomas. Clinical data were extracted from the hospital information system. Missing data were imputed with the multiple imputation of chained equations method, and the effect of smoking on the risk of advanced adenomas was calculated by binary logistic regression models to obtain odds ratios (ORs) and 95% confidence interval. Results: Current smoking rate in patients with advanced adenomas was significantly higher than that in patients with nonadvanced adenomas (31.6% VS 23.1%), the OR of advanced adenoma for current smoking compared with nonsmoking was 1.54 (1.09, 2.18), P = 0.013, and the weighted ORs ranged from 1.50 (1.01, 2.23) to 1.58 (1.09, 2.30), and the results of sensitivity analyses were still consistent. Conclusion: In adults with Han ethnicity in South China, current smoking is a risk factor of colorectal advanced adenomas compared to nonadvanced adenomas.

Helicobacter pylori infection with atrophic gastritis: An independent risk factor for colorectal adenomas

BACKGROUND The significance of Helicobacter pylori(H.pylori)infection and atrophic gastritis(AG)in the prevalence of colorectal adenomas has been examined in a limited number of studies.However,these studies reported disputed conclusions.AIM To investigate whether H.pylori infection,AG,and H.pylori-related AG increase the risk of colorectal adenomas.METHODS This retrospective cross-sectional study included 6018 health-check individuals.The relevant data for physical examination,laboratory testing,13C-urea breath testing,gastroscopy,colonoscopy and histopathological examination of gastric and colorectal biopsies were recorded.Univariate and multivariate logistic regression analyses were performed to determine the association between H.pylori-related AG and colorectal adenomas.RESULTS Overall,1012 subjects(16.8%)were diagnosed with colorectal adenomas,of whom 143(2.4%)had advanced adenomas.Among the enrolled patients,the prevalence of H.pylori infection and AG was observed as 49.5%(2981/6018)and 10.0%(602/6018),respectively.Subjects with H.pylori infection had an elevated risk of colorectal adenomas(adjusted odds ratio[OR]of 1.220,95%confidence interval(CI):1.053-1.413,P=0.008)but no increased risk of advance adenomas(adjusted OR=1.303,95%CI:0.922-1.842,P=0.134).AG was significantly correlated to an increased risk of colorectal adenomas(unadjusted OR=1.668,95%CI:1.352-2.059,P<0.001;adjusted OR=1.237,95%CI:0.988-1.549,P=0.064).H.pylori infection accompanied by AG was significantly associated with an increased risk of adenomas(adjusted OR=1.491,95%CI:1.103-2.015,P=0.009)and advanced adenomas(adjusted OR=1.910,95%CI:1.022-3.572,P=0.043).CONCLUSION H.pylori-related AG was associated with a high risk of colorectal adenomas and advanced adenomas in Chinese individuals.

Neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas

BACKGROUND Nonfunctional pituitary adenoma is a common type of pituitary adenoma, which can lead to headache, visual field disturbance, and cranial nerve damage due to increased tumor volume. Neuroendoscopic and microscopic transsphenoidal approaches have been widely used in the resection of nonfunctional pituitary adenomas. However, the clinical efficacy in neuroendoscopic and microscopic surgery is still controversial. AIM To explore the clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas. METHODS We retrospectively analyzed 251 patients with nonfunctional pituitary adenomas;138 underwent neuroendoscopic surgery via transsphenoidal approach, and 113 underwent microscopic surgery via transsphenoidal approach between July 2010 and September 2015. All patients were followed up for > 6 mo. Gender, age, course of disease, tumor diameter, tumor location, and percentage of patients with headache, visual impairment, sexual dysfunction, and menstrual disorders were contrasted between the two groups to compare the difference of preoperative data. Cure rate, symptom improvement rate, recurrence rate, the postoperative hospital stay, operating time, intraoperative blood loss, and the incidence of postoperative complications were compared in order to evaluate the advantages and disadvantages of neuroendoscopic and microscopic surgery.RESULTS There was no significant difference in cure rate, symptom improvement rate, and recurrence rate between neuroendoscopy group and microscopy group (82.6% vs 85.8%, P > 0.05;90.6% vs 93.8%, P > 0.05;5.1% vs 9.7%, P > 0.05). In the neuroendoscopy group, the postoperative hospital stay was 8.4 ± 0.6 d;operating time was 167.2 ± 9.6 min;intraoperative blood loss was 83.4 ± 9.3 mL, and the rates of diabetes insipidus and electrolyte imbalance were 4.3% and 8.0%, respectively. The corresponding results in the microscopic group were 11.2 ± 0.6 d, 199.7 ± 9.3 min, 138.8 ± 13.6 mL, and 32.7% and 20.4%, respectively. There were significant differences in postoperative hospital stay, operating time, intraoperative blood loss, and the rates of diabetes insipidus and electrolyte imbalance between the two groups (P < 0.05). CONCLUSION Neuroendoscopic and microscopic transsphenoidal approaches have similar clinical efficacy for the resection of nonfunctional pituitary adenomas. Neuroendoscopic surgery reduces operating time, intraoperative bleeding, postoperative recovery, and complications.

Bilateral adrenocortical adenomas causing adrenocorticotropic hormone-independent Cushing's syndrome: A case report and review of the literature

BACKGROUND Adrenocorticotropic hormone(ACTH)-independent Cushing's syndrome(CS) is mostly due to unilateral tumors, with bilateral tumors rarely reported. Its common causes include primary pigmented nodular adrenocortical disease,ACTH-independent macronodular adrenal hyperplasia, and bilateral adrenocortical adenomas(BAAs) or carcinomas. BAAs causing ACTHindependent CS are rare; up to now, fewer than 40 BAA cases have been reported. The accurate diagnosis and evaluation of BAAs are critical for determining optimal treatment options. Adrenal vein sampling(AVS) is a good way to diagnose ACTH-independent CS.CASE SUMMARY A 31-year-old woman had a typical appearance of CS. The oral glucose tolerance test showed impaired glucose tolerance and obviously increased insulin and Cpeptide levels. Her baseline serum cortisol and urine free cortisol were elevated and did not show either a circadian rhythm or suppression with dexamethasone administration. The peripheral 1-deamino-8-D-arginine-vasopressin(DDVAP)stimulation test showed a delay of the peak level, which was 1.05 times as high as the baseline level. Bilateral AVS results suggested the possibility of BAAs.Abdominal computed tomography showed bilateral adrenal adenomas with atrophic adrenal glands(right: 3.1 cm × 2.0 cm × 1.9 cm; left: 2.2 cm × 1.9 cm × 2.1 cm). Magnetic resonance imaging of the pituitary gland demonstrated normal findings. A left adenomectomy by retroperitoneoscopy was performed first,followed by resection of the right-side adrenal mass 3 mo later. Biopsy results of both adenomas showed cortical tumors. Evaluations of ACTH and cortisol showed a significant decrease after left adenomectomy but could still not be suppressed, and the circadian rhythm was absent. Following bilateral adenomectomy, this patient has been administered with prednisone until now,all of her symptoms were alleviated, and she had normal blood pressure without edema in either of her lower extremities.CONCLUSION BAAs causing ACTH-independent CS are rare. AVS is of great significance for obtaining information on the functional state of BAAs before surgery.

Texture and color enhancement imaging for detecting colorectal adenomas: Good, but not good enough

Texture and color enhancement imaging(TXI)has been developed as a novel image-enhancing endoscopy.However,the effectiveness of TXI detecting adenomas is inferior to narrow band imaging.Thus,future studies will need to focus on investigating the feasibility of such combination in clinical settings in order to provide patients with more accurate diagnoses.

Birthplace is not a determinant of colorectal adenomas

AIM:To examine the impact of the patient’s birthplace on the prevalence of colonic polyps and histopathological subtypes.METHODS:This is a retrospective audit of the colonoscopy practice of one Gastroenterologist in a tertiaryreferral hospital from 2008 to 2011.Data collected include demography,birthplace,language spoken,details of the colonoscopy including indications,completion rates,complications,results including prevalence and histopathology of polyps.Statistical methods used were binary logistic regression,χ2 and Mann-Whitney U.RESULTS:A total of 623 patients(48%male,67%aged over 50 years)were recruited and categorised according to birthplace:Australia/New Zealand 42%,European 20%,Asian 15%,Middle Eastern/African11%,South American 9%and Pacific Islander 3%.The median age of the cohort was 56.3 years(range:17-91 years),median body mass index 27.3 kg/m2 (range:16-51 kg/m2),25%were smokers,25%had hypercholesterolemia,20%had diabetes mellitus 16%were on aspirin and 7%were on non-steroidal antiinflammatory drugs.A total of 651 colonoscopies were performed for standard indications.The prevalence of polyps varied according to patient’s birthplace:Europe45.1%,Australia and New Zealand 39.5%,Pacific Islands 33.3%,Asia 30.3%,Middle East and Africa26.9%and South America 24.5%(P=0.027,df=6).However,multivariate analysis revealed that birthplace was not an independent predictor of developing polyps,including adenomas and advanced adenomas after correcting for age and male sex.CONCLUSION:Birthplace is not a predictor for developing colorectal neoplasia,including adenomas and advanced adenomas;hence,should not influence the recommendations for colorectal cancer screening.

Ultrastructural and Immunoelectron Microscopical Study of Human Pituitary Somatotroph Adenomas and Prolactinomas

Nowdays the application of immunohistochemical techniques and ultrastructuralanalysis and correlation with clinical and biochemical findings have led to a moredetailed functional classification,in which growth hormone (GH)-producing andprolactin (PRL)-producing adenomas have been shown to comprise more than halfof pituitary adenomaso.Few immunoelectron microscopic studies on GH and PRLadenomas have been made,however,in limited cases so far,though a numberof authors have described the characteristics of pituitary adenomas by conventionalelectron microscopy.In addition to routine electron microscopy,immuno-.electron microscopical technique using protein A-gold probes was applied in

The clinical characteristics of three subgroups of non-functioning pituitary adenomas

Introduction: Despite the fact that non-functioning pituitary adenomas do not overproduce hormones, many will stain positive for a particular pituitary hormone, which can be used to differentiate these adenomas into subgroups. If these different sub-groups behave differently in terms of post surgical progression of disease (PSPD) rates or other clinical variables, then better treatment and prognosis could be predicted. Methods: This was a retrospective cohort study. Patients who have undergone surgery for removal of a non-functioning pituitary adenoma at Emory University Hospital served as the source for all data used in this study (n = 184). Data were collected from a database of electronic medical records (EMRs) for these patients in 2010 documenting clinical and demographic variables including treatment and PSPD. Results: Risk for PSPD did not differ by adenoma subtypes: follicle-stimulating hormone (FSH+), luteinizing hormone (LH+), or those that do not stain positive for any hormone (non-functioning, or NF?) (p = 0.971). There were two clinical characteristics statistically related to adenoma subtype: altered mental status and the anterior-posterior (AP) dimension of pre-operative adenomas. PSPD was related to several clinical characteristics, including gender, previous adenoma, post-operative residual, and follow-up time.

The etiology,clinical features and medical treatment of somatotroph adenomas

Somatotroph adenomas lead to hypersecretion of growth hormones(GH)and may cause mass effects.Patients with somatotroph adenomas may present with acral and soft tissue enlargement,joint pain,heart and respiratory failure,diabetes mellitus and hypertension,resulting in increased morbidity and mortality.Early diagnosis and treatment are therefore important in prolonging life and improving quality of life.Recent studies depicted the landscape of genetic and epigenetic changes in sporadic somatotroph adenomas.New approaches are being developed for genetic testing,diagnosis and surveillance,which are helpful in early diagnosis,treatment and disease control of somatotroph adenomas.Data suggest that patients with somatotroph adenomas are best treated with multidisciplinary teams composed of neuro-endocrinologists,neurosurgeons,radiation oncologists and other specialists.This mini-review summarizes in a concise way the up-to-date discussion on the etiology,new diagnostic techniques and novel treatments of somatotroph adenomas.

Comparative Study between Microscopic and Endoscopic Trans-Sphenoidal Surgery for Growth Hormone-Secreting Pituitary Adenomas with Super-Sellar Extension

Background: Advances in the era of modern micro-neurosurgery enabled a reduction of surgical invasiveness and brain retraction which has been defined as minimally invasive or keyhole surgery. Sinonasal endoscopy has brought radical changes in the concepts of pathophysiology and treatment of sinonasal aliments as well as surgical techniques. Aim of the Study: To compare between the use of endoscopic and microscopic trans-sphenoidal approach in resection of growth hormone-secreting pituitary adenomas with Suprasellar Extension. Patients and Methods: This is a prospective study. It had been conducted upon 20 patients having growth hormone secreting pituitary adenoma admitted to Neurosurgery department in Alzar University hospitals and Nasr City Insurance hospital from 2015 to 2018, divided into 2 groups;group A (10 cases) underwent endoscopic endonasal trans-sphenoidal pituitary adenoma resection, while group B (10 cases) operated upon using the standard microscopic trans-sphenoidal pituitary adenoma resection. The inclusion criteria were included: All patients with growth hormone secreting pituitary adenomas showing manifestations of acromegaly, mass effect or hormonal disturbance. Results: This study showed that improvement in outcome was higher in endoscopic group opposed to microscopic group (100% vs. 71% improved headache, 80% vs. 60% visual improvement, 75% vs. 20% fundus improvement and 60% vs. 30% field improvement). Conclusion: We concluded that fully endoscopic procedure result in improved rates of complete tumor removal and a reduced incidence of complications, when compared to the microscopic approach.

Endoscopic Endonasal Surgery for Clinically Nonfunctioning Pituitary Adenomas

Background: Clinically nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary macroadenomas, and represent approximately one-third of all pituitary adenomas. Patients often present with symptoms of mass effects, such as visual field defects, chronic headache, and hypopituitarism. Objective: The objective of this study was to retrospectively analyze the surgical results of 35 patients with non-functioning pituitary adenomas (NFPAs) operated by the endoscopic endonasal approach (EEA). Surgical outcomes including postoperative complications, recurrence and the postoperative visual and endocrine profile were assessed. Results: This retrospective study included 35 patients operated for clinically nonfunctioning pituitary adenomas (NFPAs) in Al Azhar university hospitals treated by endoscopic endonasal approach (EEA) in the last 6 years. 65.7% (n = 23) were male and 34.3% (n = 12) were female. The mean age was 41.5 (range 18 - 65) years. The most common presenting symptoms were headache, with 60% of the patients having headache. Visual disturbances were the presenting symptom in 82.9% patients and endocrinological problems (panhypopituitarism) were present in 6 (17.1%) patients. The number of patients suffering from cranial nerve deficit was 2 (5.7%). Visual acuity and visual field improved in 23 (79.3%) of 29 patients. The rate of tumor recurrence/regrowth was higher in the case of giant adenomas and cavernous sinus invasion represented 11 patients (31.4%). Conclusions: Early endoscopic endonasal approach surgery of NFPAs and effective surgical decompression reduces morbidity. Visual deficit improves in two third of cases. NFPAs represent high rate of recurrence due to invasion or incomplete resection especially with giant adenomas. The recurrence rate with growth total resection (GTR) is lower than subtotal resection (STR).

Medical management of pituitary adenomas:a study of ultrastructural changes and receptor expressions

Objective The aim of this study is to analyze the ultrastructural changes and dopamine 2 receptor (D2R) expression levels of pituitary adenomas to clarify the mechanism of medical management. Methods 9 patients with prolactinomas and 4 with nonfunctioning pituitary adenomas(NFPAs) were treated with bromocriptine preoperatively. Ultrastructure changes of tumor cells were observed through electron microscopy.

Expressions of osteopontin and CD44v6 and their clinical significance in pituitary adenomas

Objective To explore expressions of osteopontin (OPN) and CD44v6 in pituitary adenomas and to evaluate relationship between expressions and invasiveness of tumor. Methods Immunohistochemistry was used to detect expressions of OPN and CD44v6 in 80 pituitary adenomas,and

The causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenomas surgery

Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed. CSF leak occurred

Analysis of complications of transsphenoidal surgery for pituitary adenomas

Objective To analyze the complications of transsphenoidal operation for pituitary adenomas. Methods Postoperative complications of 323 patients underwent transphenoidal surgery for pituitary adenoma between January 2001 and December 2009 in our department were retrospectively reviewed. Results Insipidus was the most common complication after