经蝶窦显微外科切除垂体生长激素腺瘤(104例疗效分析)

报告104例经蝶窦显微外科切除垂体生长激素腺瘤。1986年6月前的57例中,微腺瘤的治愈缓解率为46.2%,大腺瘤为35.5%。以后的47例由于手术技术的提高和经验的积累,微腺瘤和大腺瘤的治愈缓解率分别为70%和64.8%。本文对影响疗效诸因素及手术并发症的防治进行讨论。     

PITUITARY ADENOMAS WITH ACROMEGALY LIGHT MICROSCOPIC AND ELECTRON MICROSCOPIC STUDY OF 60 CASES

Analysis of 60 pituitary adenomas with acro- megaly iiS made. All 60 surgical specimens are studied by both light and electron microscopy. By light microscopy we classified the adenomas into strong acidophilic cell (16 cases) and weak acidophilic cell (20 cases), stem cell (2 cases) and mixed cell type adenomas (22 cases). By electron micros.copy we classified them into densely granulated (14 cases) and sparsely granu- lated growth hormone (GH) cell adenomas (212 cases) in which there are fibrous bodies near the indented part of the nucleus which are of diagnostic value, corresponding to the round lucent area near the indented nucleus seen by light microscopy. The densely granulated and sparsely granulated GH cells may coexist within 1 adenoma (4 cases). Some adenomas may con- tain 2-3 kinds of secretory granules and are called multiple functional adenomas, in this series 18 had GH-;-PRL prolactin), 1 GH+ACTH and l GH+PRL+ACTH. Strong acidophilic cells correspond to densely granulated GH cells while weak acidophilic celIs correspond to sparsely granulated GH cells. The number of strong or weak acidophilic cells and number of secretory granules are not directly proportional to the GH blood level. By electron microscopy GH, PRL and ACTH secretory granules have characteristic features which are not absolute. Correct diagnosis is based upon combining the clinical symptoms and signs, blood hormone levels and secretory granule morphology. F'ibrous body diagnostic value and their genesis and development are dis- cussed.     

流行性乙型脑炎疫苗接种后的脑脊髓炎(附4例尸检分析)

报告接种鼠脑制的流行性乙型脑炎疫苗后脑脊髓炎4例的尸检材料。均表现为中枢神经系统白质的血管周围有淋巴细胞浸润,例1为亚急性发病的成年人,血管周围尚有脱髓鞘和出血灶。3例急性发病的儿童均有胸腺增大、肾上腺缩小和淋巴网状细胞增生。这4例均为鼠脑引起的变态反应性脑脊髓炎,其中3例属早期病变。     

垂体生长激素细胞腺瘤的免疫细胞化学染色与电镜观察30例的结果比较研究

利用伴有肢端肥大症的垂体腺瘤30例的手术切除的瘤组织,做电镜检查,并做免疫细胞化学染GH。对比了滴染法与小盒长期浸泡法染GH的优缺点。在电镜下对垂体GH细胞腺瘤可分为多分泌颗粒、少分泌颗粒或多与少分泌颗粒混合性细胞腺瘤。在免疫细胞化学染GH中,可分为GH强阳性和弱阳性细胞或二者的混合,在电镜下的多分泌颗粒细胞相当免疫细胞化学染色中的GH强阳性细胞,少分泌颗粒细胞相     

颅内脂肪瘤2例报告

颅内脂肪瘤约占颅内肿瘤的0.34～0.46％。过去的病例多在尸检中偶被发现。自CT应用后,因颅内脂肪瘤的好发部位及其特征性的CT表现,多数病例生前可确诊。本文报导1例胼胝体脂肪瘤及1例罕见的鞍区脂肪瘤。     

AUTOPSY ANALYSIS OF 200 STROKE CASES

In 200 autopsies of stroke cases, there were 99 cerebral hemorrhages including hypertensive cerebral hemorrhage 78, cerebral blood vessel anomalies 7, anemia 5, leukemia 4, tuberculous meningitis 2, septicemic, cerebral hemorrhage l, severe jaundice complicated by cerebral hemor- thage l and posttraumatic subdural hemorrhage 1. There were 53 cerebral infarctions in which there were cerebral embolisms 48, cerebral thrombosis 4 and cerebral venous thrombosis l. There were also hypertensive encephalopathy 15, cerebral tumors 33 including primary brain tumors complicated by hemorrhage 2, metastatic choriocarcinoma 25 and other matastatic carci- nomas 6. According to our autopsies cerebral he- morrhage is the most frequent cause of stroke with cerebral embolism ranking second while cerebral thrombosis is much less important. Ce- rebral atherosclerosis developed progressively over a very long course and it does not trigger strokes if it is without complications.     

HYPERPROLACTINEMIA ITS RELATION TO GALACTORRHEA, AMENORRHEA, PITUITARY TUMOR AND ITS MANAGEMENT

Hypperprolactinemia and its relation to galactorrhea, amenorrhea and pituitary tumor were studied in 355 cases. Hyperprolactinemia was found in 135 cases, and its incidences in the 3 groups (galactorrhea with amenorrhea, galactorrhea with menstruation and amenorrhea without galactorrhea) were 78.2u/o (111/ 142), 21.7% (18/83) and 4.6:vo(6/130) respectively, the differences being statistically significant (p<0.01). Of the hyperprolactinemia cases 9570 had galactor- thea, and about half of them were discovered during examination. Therefore, pressing the breasts for milk should be a routine procedure during gyno cologic examination. There were 60 pituitary ma croadenomas in this series; the incidence of hyperprolactinemia was 39.3To (53/153) and amenor thea with galactorrhea was 37.3%(53/'142). There fore, prolactinoma is the most important cause of galactorrhea, amenorrhea and hyperprolactinemia. Some prolactinomas may not be accompanied by amenorrhea, galactorrhea or hyperprolactinemia. 42 cases of hyperprolactinemia, half with pituitary tumors, were treated with bromocriptine. Menstrua tion resumed in 95.2%, biphasic basal body tempera. ture (BBT) in 90.5%, and 70.6To infertile patients became pregnant. The present study shows that the important cause of amenorrhea is functional dis turbance in the hypothalamic-pituitary-ovarian axis. Once prolactin level is lowered, functional distur- bances can be corrected very quickly.     

垂体腺瘤的新分型及诊断

日常外检中常遇到的垂体疾病是垂体腺瘤,它约占颅内肿瘤的11%,近年来,由于内分泌学检查方法的发展,CT的广泛应用和外科手术治疗方法的改进,垂体腺瘤的诊断符合率和疗效有很大的提高。     

垂体泌乳素细胞腺瘤的免疫细胞化学染色与电镜观察30例的结果比较研究

利用垂体泌乳素细胞腺瘤30例的手术切除的瘤组织,做了电镜检查和免疫细胞化学的检查,在电镜下可分为多分泌颗粒PRL细胞腺瘤和少分泌颗粒PRL细胞腺瘤以及二者的混合。用免疫细胞化学染PRL,少分泌颗粒的PRL细胞有特点:PRL阳性物质大都呈一边界清楚的团块,其中有棕黄色的颗粒,它们的大小、形状变异大,但都位于核的一侧,在核有凹陷而且胞浆多的一侧。这个PRL阳性团块相当于电镜下的泌乳素小体。瘤细胞内PRL阳性物质少甚或阴性的     

甲状腺低功所致垂体促甲状腺素、催乳素混合腺瘤(1例报告及文献复习)

甲状腺低功所致垂体促甲状腺素、催乳素混合腺癌很罕见。本例的临床及实验室主要特征为:甲状腺低功,闭经,溢乳,视力左0.1,右0.3,双颞侧偏盲,血清T_4、T_3U值下降及PRL升高,甲状腺微粒抗体增加,TRH对TSH刺激试验呈过强反应。术后肿瘤超微结构检查发现瘤细胞内有TSH、PRL分泌颗粒及微小管。术后视功能迅速恢复,1个半月后月经来潮,溢乳停止,血TSH、PRL接近正常。