Brain tumors (second of two parts)

Article Abstract:

Surgery is a common part of the treatment for brain tumors. Often, surgical removal of a brain tumor is necessary for a definitive diagnosis of what type of tumor is present. However, in contrast to the situation for the rest of the body, the type of tumor may not be important in determining the best treatment or in assigning a prognosis. For example, a brain tumor may be found to be benign when examined under the microscope. But if part of the tumor cannot be completely removed due to its location next to some critically important structure in the brain, the 'benign' tumor can be fatal. The most common benign brain tumor is the meningioma, which arises in the meninges, the membranes that cover the brain. About 15 percent of all brain tumors are meningiomas, and a majority of meningiomas appear to contain some abnormality involving chromosome 22. Meningiomas are twice as common in women than men, and seem to be under hormonal control. If the meningioma is located in a spot amenable to complete surgical removal, cure is possible. However, from 8 to 11 percent of patients will nevertheless suffer a recurrence within a decade. Pituitary adenomas are tumors of the pituitary gland containing cells that appear to be secretory. Pituitary adenomas may or may not actually secrete any hormone, however. With the advent of magnetic resonance imaging and CT scans, it has become more common to discover pituitary adenomas prior to the occurrence of any symptoms. Surgery can be very effective for pituitary adenoma; in one study 85 percent of the surgically treated patients had their tumors controlled, and those patients who were treated with radiation in addition to surgery did even better. Gliomas are the most common malignant brain tumor; these are most often astrocytomas, which arise from astrocytes, an exceptionally common brain cell. Low-grade astrocytomas are more common among children; in adults, gliomas are more likely to be high-grade, or more malignant. Glioblastoma multiforme is probably one of the most malignant of all tumors occurring in man; the two-year survival rate for glioblastoma multiforme is about 5 percent. Other forms of brain tumors include oligodendroglioma, medulloblastoma, primary brain lymphomas, and metastatic brain tumors (tumors that have spread to the brain from cancers arising in other parts of the body). (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Glioblastoma multiforme, Brain tumors, Meningioma, Astrocytoma, Astrocytomas

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Diagnosis and management of hormone-secreting pituitary adenomas

Article Abstract:

The authors provide a review of the diagnosis and management of hormone-secreting pituitary adenomas. Adenomas are tumors that have histological similarities to secretory cells. In some pituitary adenomas, the symptoms of the tumor are a result of the hormone secretion, while in others the mass effect of the growing neoplastic tissue is the source of the symptoms. Cushing's disease results from an oversecretion of corticotropin by the pituitary gland. This excess of corticotropin, which is most often the result of a secreting adenoma, stimulates the overgrowth of the adrenal cortex and the subsequent overproduction of steroid hormones. The major diagnostic problem in Cushing's disease is distinguishing the effects of a pituitary problem from the effects of a primary overproduction of corticosteroid by the adrenal cortex or by some other tumor. One popular test for this purpose is the overnight response to dexamethasone; the urine is examined in the morning for an increase in cortisol resulting from stimulation with dexamethasone at midnight. Like all tests of corticotropin physiology, however, it is not perfect. Not all pituitary adenomas respond as predicted, and some tumors can mimic the response of a pituitary adenoma. Pituitary adenomas that secrete glycoprotein hormones, such as follicle-stimulating hormone and luteinizing hormone, are not recognized by their production of hormone, but rather by the headaches, visual loss, and reduction of pituitary function which develop as the tumor mass grows. In most cases, the tumor mass extends beyond the sella turcica, the body cavity that holds the pituitary. Pituitary adenomas that secrete growth hormone, however, have a drastic effect on the body, causing acromegaly, or the excessive growth of the nose, jaws, ears, fingers, and toes. Generally, surgery is the best treatment for these tumors and modern improvements in techniques have resulted in a success rate better than 90 percent. Prolactinomas, however, are an exception to this. These tumors, which secrete the hormone prolactin, are generally treated with the dopamine agonist bromocriptine. Surgery for these tumors is not always curative and recurrences are possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Cushing syndrome, Adenoma

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A 64-year-old woman with the abrupt onset of paraparesis after 10 months of increasing episodic leg weakness

Article Abstract:

A 64-year-old woman was diagnosed with an arteriovenous fistula in her spine. An arteriovenous fistula is an abnormal opening between an artery and vein that results in an aneurysm. She was admitted to the hospital with partial paralysis of her legs, and pain in her lower back and buttocks. The patient had a history of hypertension and had one heart attack 10 years earlier. The patient underwent an MRI scan which revealed that she did not have a tumor. A CT scan and an X-ray of the spinal cord revealed an arteriovenous fistula. The patient underwent treatment with different substances to block the opening between her artery and vein. She spent three and a half months in a rehabilitation hospital following treatment. She regained the much of the strength in her right leg, and her sense of feeling in both legs. She still had weakness in her left leg and lower back pain.

Case studies, Fistula, Arteriovenous, Arteriovenous fistula

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