鞍旁海绵状血管瘤的MRI诊断及误诊分析

目的:分析鞍旁海绵状血管瘤MR影像特点及误诊原因,提高对该疾病的诊断及鉴别诊断水平。方法:收集我院经手术病理证实的13例鞍旁海绵状血管瘤,术前均行MRI平扫及增强扫描,5例行3D-ASL检查,分析其影像学资料。结果:9例表现为横向哑铃状,鞍旁大,鞍内小,病灶主体位于颈内动脉外侧,颈内动脉海绵窦段被病灶包绕;1例鞍旁与鞍内病灶大小相似,1例病灶主体位于颈内动脉内侧,2例病灶完全位于颈内动脉外侧;7例垂体显示不清,6例垂体受推移;6例T2W I表现为类似脑脊液的极高信号;仅5例行3D-ASL检查,病灶均呈低灌注。误诊9例,其中4例误诊垂体腺瘤,5例误诊脑膜瘤。结论:横向哑铃状、病灶主体位于颈内动脉外侧及T2W I类似脑脊液的极高信号是鞍旁海绵状血管瘤的典型影像特征。对于不典型病变,借助3D-ASL可以减少误诊,充分掌握MRI影像特征及鉴别诊断的要点,对提高临床术前诊断水平具有重要价值。     

Size of the sella turcica and its relation to iron deficiency anemia: a prehistoric example

This paper examines the usefulness of volume and area assessments of the sella turcica from radiographs in order to aid in the differential diagnosis of iron deficiency anemia in past populations. Lateral and posterior-anterior radiographs were taken of each cranium in the sample. The length, depth, and width of the sella turcica were then measured directly from the appropriate view, and subsequently the volume and area were calculated for each. The 20-25 year-old cohort was found to yield the most promising results; however, a statistical difference was not found to exist using the volume or area. The width dimension was found to be of far more use than any other in this study. In no instance was any feature of typical porotic hyperostosis, visually or radiographically, found to be statistically correlated with any difference in the dimensions of the sella turcica. A discussion of how the various dimensions of the sella turcica react to changes in size of the hypophysis cerebri is presented.     

Pit membrane remnants in perforation plates and other vessel details of Cornales

Perforation plates and other vessel details as studied with scanning electron microscopy (SEM) have been reported for four species of Cornaceae (s.l.): similar features are shown by the four, suggesting that a more extensive sampling of the family might reveal similar phenomena. Perforation plates contain pit membrane remnants in the form of threads or, less commonly, laminar portions perforated by pores. When least well-represented, the pit membrane remnants are restricted to lateral ends of perforations and to the perforations transitional to lateral wall pitting. Perforations are all clearly bordered. Helical thickenings that do not form a continuous gyre are reported for the vessel walls ofAucuba. The presence of pit membrane remnants in vessel elements of Cornaceae correlates with the mesic habitats occupied by species in this family. The presence and type of pit membrane remnants reported by us in the three genera is very similar, although pit membrane remnants are doubtless a symplesiomorphy and thus not an indicator of relationships. The presence of pit membrane remnants in the three genera, however, does attest to the primitiveness of wood and other features of Cornaceae s.l.     

Notes on the position of the true freshwater crabs within the brachyrhynchan Eubrachyura (Crustacea: Decapoda: Brachyura)

Cladistic and phenetic relationships of 51 eubrachyuran crab genera, comprising 36 genera of marine crabs and 18 genera of true freshwater crabs from 7 families, were investigated using 121 parsimony-informative adult morphological characters. The data matrix was subjected to four different treatments: (1) a cladistic analysis with a combination of unordered and ordered characters, (2) a cladistic analysis with all characters unordered, (3) neighbour-joining, and (4) UPGMA phenetic analyses. The parsimony analysis conducted with a combination of ordered and unordered characters produced a set of hypotheses which supported monophyly of a Pseudothelphusidae+Potamoidea clade. Furthermore, exemplar genera of the Bythograeidae and Pinnotheridae formed an unresolved polytomy with the Pseudothelphusidae+Potamoidea group, the Thoracotremata. The trichodactylid freshwater crabs were positioned as the sister taxon of the basal portunoid Carcinus, but were unresolved relative to other portunoids and geryonids. Second, the parsimony analysis conducted with all characters unordered resulted in a [bythograeid, pseudothelphusid+potamoid, pinnotherid, thoracotreme] group with no hierarchical resolution, which in turn formed a polytomy with a goneplacid+portunoid clade and a polyphyletic Xanthoidea. And third, phenetic groupings of the eubrachyuran genera invariably placed the pseudothelphusids with the potamoids, and this clustered with a group containing the thoracotremes (either in whole or part). Support was thus found for morphological connections among the nontrichodactylid freshwater crabs, thoracotremes, bythograeids, and pinnotherids, and for the placement of the trichodactylids within the Portunoidea. These two latter findings (that used a range of genera from each family) are broadly congruent with a previous cladistic analysis of selected eubrachyuran familial groundpatterns that used a basal exemplar of each marine and freshwater crab family (Sternberg et al., 1999). However, it is clear that the large scale homoplasy identified here may nullify any reliable hypothesis of brachyrhynchan groupings at this stage.     

Computerized planning of radiotherapy]

The hypophysis was studied by MR tomography in 148 patients with the most prevalent diseases of the hypothalamohypophyseal system and in 13 ones with primary hypothyrosis. The findings evidence a great variety of changes in the MRT picture in the examinees. The method permits a reliable diagnosis of hypophyseal macroadenoma and of an 'empty' sella turcica. Qualitative and quantitative criteria for MRT diagnosis of these conditions are suggested. The diagnostic value of MRT for the detection of macroadenomas is still to be researched. The method was effectively used for a dynamic follow-up of the hypophyseal status in the course of pathogenetic therapy; the formation of an 'empty' sella turcica is possible against the background of dopamine agonist therapy and substitution therapy of primary hypothyrosis.     

Functional evaluation of the adenohypophysis with metoclopramide in hyperprolactinemic-amenorrheic women in relation to radiological findings on the sella turcica

The responses of the adenohypophyseal hormones to metoclopramide (MCP) were evaluated in hyperprolactinemic women with various radiological findings on the sella turcica. Serum PRL concentrations significantly increased after MCP administration in normal women, hyperprolactinemic patients with normal sella and patients with microadenoma, but not in macroadenoma patients with and without suprasellar expansion (SSE). The PRL response to MCP administration was significantly lower in hyperprolactinemic patients than in normal women. Serum TSH concentrations significantly increased after MCP administration in each group of subjects. The TSH response to MCP was significantly higher in patients with normal sella and patients with microadenoma than in normal women. However, the responses of PRL and TSH to MCP were not significantly different between patients with normal sella and patients with microadenoma. Therefore, they were not considered useful in distinguishing tumorous from nontumorous hyperprolactinemia. Serum LH concentrations significantly increased after MCP administration in patients with normal sella, patients with microadenoma and macroadenoma patients without SSE, but not in normal women or macroadenoma patients with SSE. The LH response to MCP was significantly higher in patients with microadenoma than in patients with normal sella. Serum FSH concentrations significantly increased after MCP administration only in patients with microadenoma. The different responses of the adenohypophyseal hormones to MCP in hyperprolactinemic women with various radiological findings on the sella turcica may be explained by the difference in the hypothalamic dopamine activity and in the impairment of the hypothalamic-pituitary system due to pituitary tumor.     

The Saethre-Chotzen syndrome with partial bifid of the distal phalanges of the great toes

Summary The authors describe three cases of familial acrocephalosyndactyly (ACS) in two boys (9 and 3 years of age) and in their 7.5-year old sister. In addition, irregularities in skull and limbs were found in the 46-year old father as well as in two other children, i.e., two girls, 14 and 4 years of age. The mother (46 years-old) and the remaining four 4 boys (12-, 9-, and 7-years-old), as well as the youngest child, a son, (1-year-old) did not show any deviations.The diagnosis of the Saethre-Chotzen syndrome in six members of one family was based on the finding of a typical skull deformation (oxybrachycephalia), low hairline, flattened nasofrontal angle, lateral deviation of the nasal septum, facial dysmorphy, prolapse of upper eyelids, antomongoloid placement of palpebral fissures, protruding eyes, hypertelorism, dysmorphy of auricles, imperfect hearing, highly arched palate, improper dentition, and characteristic skin syndactyly of hands and feet. In addition, deformed chest, weight and height deficiency, significant mental retardation, as well as, in the boys, true cryptorchidism were found. Radiological examination showed, in all affected members of the family, intensified digitate impressions within the whole fornix of the skull, large and deep sella turcica, underdeveloped frontal bone and upper jaw bone, untypical syndactyly of hands and feet, and the partial bifid of distal phalanges of the great toes, not described previously in the Saethre-Chotzen syndrome. In the differential diagnosis, other forms of ACS, i.e., Apert, Vogt, Pfeiffer, Summitt, and Herrmann-Opitz syndromes, were not found.Manifestation of the described symptoms transferred autosomally, dominantly, and with a similar degree of expression in 6 of 11 members of one family, leads us to think that they are the consequence of a fresh mutation revealed in the father.     

Primary empty sella with isolated ACTH deficiency and microprolactinoma

The empty sella turcica is defined as the herniation of the subarachnoid space within the sella with displacement of the pituitary towards the posteroinferior wall. By autopsy studies, the incidence in the general population is around 20%. The association of prolactinoma and empty sella has been coincidental & infrequently reported. As such for microadenoma, visual field testing and screening for hypopituitarism is not needed, but if it is associated with empty sella, both visual field testing and screening for hypopituitarism is necessary.     

Prolactin studies in "functionless" pituitary tumours.

Hyperprolactinaemia was found in all 17 women and in one out of six men who presented with hypogonadism and a radiologically enlarged sella turcica but no other clinical endocrine dysfunction. Some of the women also had galactorrhoea. The greater the level of hyperprolactinaemia in these 18 patients the larger their sellae turcica except in two patients with unusual features. The sella turcica was usually asymmetrically enlarged and there was rearly an upward extension of tumour, though the sella floor often showed some erosion on tomography. An oral dose of bromocriptine suppressed the hyperprolactinaemia in mose patients at the same rate as in normal post-partum women. Nine of the 18 patients with hyperprolactinaemia had low basal luteinizing hormone (LH) levels. The LH responsiveness to 100 mug of LH-releasing hormone (LHRH) was tested in 12, and eight showed subnormal values. Of eight biopsy specimens obtained four showed acidophil granules on light microscopy, and in five granules of various sizes were seen on electron microscopy.     

A case of hyponatremia in panhypopituitarism caused by the primary empty sella syndrome

A 64-year-old woman was admitted for evaluation of hyponatremia. She was maintained on hypertonic saline administration. Without this therapy, the serum Na concentration decreased progressively to 127 mEq/L and the plasma osmolality to 254 mOsm/Kg H2O, on Day 3. At that time, the concentration of antidiuretic hormone (ADH) was as high as 3.5 pg/ml. A skull radiogram revealed an enlarged sella turcica. Computed tomography (CT) revealed a low density in the sella, and magnetic resonance imaging revealed equal intensity of the sella turcica and the cerebrospinal fluid. A diagnosis of empty sella syndrome was made by metrizamide cisternography in conjunction with CT scanning. A diagnosis of panhypopituitarism was made by endocrine function tests. 123I-thyroidal uptake was 6% when her serum TSH was 10.9 microU/ml, suggesting that she might also have primary hypothyroidism. When this patient was given glucocorticoid before levothyroxine replacement, her serum Na concentration rose up to about 140 mEq/L and a normal relationship between her plasma ADH level (2.4 pg/ml) and plasma osmolality (281 mOsm/kg H2O) was restored. Therefore, it was suggested that ADH hypersecretion induced by the glucocorticoid deficiency might in part contribute to the development of hyponatremia. This is the case of primary empty syndrome associated with panhypopituitarism, in whom initial symptom was caused by hyponatremia.     

Interface between haustoria of parasitic members of the Scrophulariaceae and their hosts: A histochemical and immunocytochemical approach

Summary The haustorial structure of three African parasitic members of the family Scrophulariaceae (Buchnera hispida, Rhamphicarpa fistulosa, andStriga hermonthica) has been studied with regard to the interface between haustoria and the invaded host roots. Immunocytochemical observations at the light and electron microscopical level were carried out with monoclonal antibodies against pectin. JIM5, JIM7, and hydroxyproline-rich glycoprotein (HRGP), LM1. Lignins have been visualized by phloroglucinolhydrochloric acid staining. At the margin of the lateral interface (contact area of host root cortex and parasite cells), JIM5- and JIM7-labelled substances accumulate between parasite papillae and the host root surface indicating that pectins are implicated in sealing the parasite to the attacked host organ. The lateral interface is characterized by the presence of compressed, necrotic host cells, whereas the central interface (contact area between host stele and parasite cells) is generally devoid of host cell remnants. Phenolic substances and/or lignins can be found at the site of penetration of the haustorium into the host root. These observations and the fact that HRGPs accumulate at the host side of the interface support the view of, at least, a partial defense reaction in the invaded host root tissues. Within haustoria, HRGPs were restricted to differentiating xylem elements, implying a spatio-temporal regulation of HRGPs in developmental processes.Abbreviations BSA bovine serum albumin - FITC fluorescein isothiocyanate - HRGP hydroxyproline-rich glycoprotein - LM light microscopy - MAb monoclonal antibody - TBSB Tris-buffered saline with bovine serum albumin - TBSB-T Tris-buffered saline with bovine serum albumin and Tween 20 - TEM transmission electron microscopy     

Pax gene expression in the developing central nervous system of Ciona intestinalis

We compare the expression patterns in Ciona intestinalis of three members of the Pax gene family, CiPax3/7, CiPax6 and Cipax2/5/8. All three genes are expressed in restricted patterns in the developing central nervous system. At the tailbud stage, CiPax3/7 is present in three patches in the brain and along the posterior neural tube, CiPax6 throughout the anterior brain and along the posterior neural tube and CiPax2/5/8 in a restricted region of the posterior brain. Double in situ hybridisations were used to identify areas of overlap between the expression of different genes. This showed that CiPax3/7 overlaps with the boundaries of CiPax6 expression in the anterior brain, and with CiPax2/5/8 in the posterior brain. The overlap between CiPax3/7 and CiPax2/5/8 is unlike that described in the ascidian Halocynthia rorezti.     

Ultrastructure of the Fusion Area during Conjugation in the Suctorian Heliphrya erhardi (Rieder) Matthes*

SYNOPSIS. The suctorian Heliophrya erhardi (Rieder) Matthes is attached to the substrate by the flattened ventral side of the cell body. The dorsal is covered by a pellicle composed of 3 unit membranes. Below the pellicle is a 0.4–0.8-μm thick epiplasm composed of 6–8-nm thick fibrils. Microtubules form a network beneath the epiplasm. The epipalsm is penetrated by tube-like pellicular pits, which are lined by the cell membrane and end beneath the epiplasm in a saccule-like enlargement. During conjugation, 2 neighboring organisms form cytoplasmic processes which come into contact and fuse, thus forming a cytoplasmic bridge between the 2 cells. Around the bridge the pellicles of both organisms fuse, and the partners become united by a continuous common membrane system. Across the entire conjugation bridge the 2 fused epiplasms form a septum. Tube-like structures can be seen lying partly in the epiplasmic septum and partly in the adjacent cytoplasm. These structures are open at both ends and represent remnants of the pellicular pits. No trace of the original pellicular membranes can be found at the fusion area within the epiplasmic septum. The cytoplasm of the conjugation partners is separated only by the fused epiplasms forming the epiplasmic septum.     

中国翼手类新记录--马氏菊头蝠

2003 年9 月8 日, 在云南省红河州弥勒县白龙洞(24°12′N , 103°21′E) 获得一号蝙蝠标本, 雄性(共捕捉和测量了7 个此种蝙蝠的个体, 但鉴于数量稀少, 故仅保留一只个体用来制作标本, 其余测量后放飞) , 经鉴定为马氏菊头蝠, 为中国新记录。本文给出了这种蝙蝠的特征描述和相关测量数据, 并对这种蝙蝠的分布进行了分析。标本保存于中国科学院动物研究所。     

Empty sella in control subjects and patients with hypopituitarism

The frequency and distribution of various degrees of empty sellae have been examined in subjects without any pituitary disorder and in patients with hypopituitarism. Among them none had sellar enlargement. Sellar computed tomography (CT) with contiguous 2 mm slices (thickness in the axial projection) was performed in 56 control subjects. The CT findings on sella turcica were graded into 4 groups (0, 1+, 2+, and 3+), and grades 2+ and 3+ indicated moderate and marked empty sellae. Thirty-nine percent of the control subjects had empty sellae of grade 2+ or 3+. Sellar CT scans with contiguous 2 mm slices were also performed in 11 patients with hypopituitarism. The sellar volume ranged from 224 to 715 mm3. CT scan was carried out more than 2 years after the onset of hypopituitarism in 10 of 11 patients, and showed typical empty sellae of grade 3+ in all 10 patients. There was no empty sella in a patient with hypopituitarism whose CT scan was carried out 3 months after the massive postpartum hemorrhage. Our results indicate that moderate empty sella of grade 2+ can be seen in subjects without any pituitary disorder, and that a typical empty sella of grade 3+ is present in hypopituitarism with a normal sized sella turcica. An empty sella associated with hypopituitarism may be due to shrinkage of the pituitary gland related to its hypofunction.     

Association of adverse perinatal events with an empty sella turcica in children with growth hormone deficiency

High-resolution computed tomography (HR-CT) of the hypothalamo-pituitary region was performed in 26 consecutive children presenting with growth hormone deficiency (GHD) at one clinic. 58% had an empty sella turcica (ES) and 42% a full sella turcica (FS). There was no difference between the ES and FS groups for mean (+/- 95% confidence limits) presentation age (ES 6.7 (+/- 1.8) years, FS 5.6 (+/- 2.2) years), height standard deviation score (SDS) (ES -3.9 (+/- 0.8), FS -3.3 (+/- 0.5] nor head circumference SDS (ES -1.9 (+/- 1.1), FS -0.7 (+/- 1.1]. There were significant associations between the ES group and a history of adverse perinatal events (p less than 0.001) and multiple pituitary deficiency (p = 0.014). Growth hormone response to an acute growth hormone releasing factor test showed no association with HR-CT diagnosis. Sella turcica volumes were calculated from the HR-CT scans. All sella volumes were small; mean SDS for height was -2.6 (+/- 0.2). There was no difference in sella volume SDS between the ES and FS groups (ES -2.9 (+/- 0.3), FS -2.5 (+/- 0.4]. Adverse perinatal events may cause an ES and GHD by compromising the blood supply to the pituitary gland or infundibulum.     

Empty sella following spontaneous resolution of a pituitary macroadenoma

BACKGROUND/AIM: Empty sella is a radiological finding characterized by the presence of arachnoid herniation into the sella, resulting in compression of the pituitary against the sella wall. The objective of this case presentation is to discuss secondary empty sella in a patient with spontaneous resolution of a pituitary macroadenoma. METHODS: A case of empty sella syndrome is presented. Static and dynamic testing was performed. Etiology, pituitary function, and imaging are discussed. RESULTS: A 69-year-old African-American woman was referred by her primary care physician for evaluation and treatment of 'hypothyroidisim'. Thyroid tests were performed because of muscle and joint tenderness and revealed low free thyroxine and normal thyroid-stimulating hormone levels. The diagnosis of secondary hypothyroidism was made, and magnetic resonance imaging (MRI) of the pituitary revealed an empty sella turcica. In retrospect, the patient had presented 11 years earlier with tinnitus, and an MRI of her auditory canals demonstrated an 'incidental' 1.5-cm pituitary tumor. No endocrine evaluation was done at that time, and neurosurgical follow-up of the pituitary tumor by serial MRIs demonstrated the genesis into empty sella. CONCLUSIONS: In our patient the natural history of her pituitary tumor was that it involuted and resulted in an empty sella. Although oftentimes speculated as a cause of empty sella, tumor involution has rarely been shown to be causative. In this instance, empty sella was associated with hypopituitarism. This case illustrates the importance of endocrine evaluation of patients with this radiological finding.     

Aneurysms of the Internal Carotid Artery Simulating Pituitary Tumours: Report of Two Cases

Two patients suffering from aneurysms of the internal carotid artery simulating pituitary tumours are reported. One of these was a 17-year-old boy with a mycotic aneurysm of the right internal carotid artery causing failure of growth and pubertal maturation. The second was a 53-year-old woman with a left internal carotid artery aneurysm, probably of atherosclerotic origin, who had evidence of anterior pituitary insufficiency.In both cases there was paresis of extraocular muscles and one patient had bitemporal hemianopsia. While lateral radiographs of the skull suggested intrasellar calcification in each case, further roentgenological investigation established that this calcification was actually extrasellar, and carotid arteriograms demonstrated the presence of an internal carotid aneurysm in each case. Investigations of the endocrine system confirmed the presence of anterior pituitary insufficiency in both patients, and diabetes insipidus became evident in one patient after cortisone therapy was commenced.This lesion, while rare, may be difficult to differentiate from a pituitary tumour. It is likely that this syndrome depends on aneurysmal expansion to the region of the sella turcica with compression of the pituitary gland itself, as well as the optic fibres.     

Increase in vasopressin concentration and cardiodepressant activity in the blood dialysates after NMDA and hypertonic saline administration.

It has been demonstrated that electric stimulation of the central ends of cut vagus nerves or angiotensin II infusion cause an increase in vasopressin concentration and cardiodepressant activity in the sella turcica venous blood. The present study was an attempt to determine if the cardiodepressant factor and vasopressin were simultaneously released from the pituitary into the blood dialysate after osmotic stimulation, and whether excitatory amino acids are involved in this mechanism. The samples of dialysates of venous blood flowing from the sella turcica region and, for comparison, from the femoral vein were collected in anaesthetised rats. The concentration of vasopressin in blood dialysate was determined by radioimmunoassay, and cardiodepressant activity on spontaneously discharging pacemaker tissue of the right auricle of the right heart atrium. Osmotic stimulation or N-methyl-D-aspartic acid infusion caused an increase in cardiodepressant activity and vasopressin concentration in the blood dialysate from the sella turcica and from the femoral vein. A blockade of the excitatory amino acids receptors by specific and non-specific antagonists significantly inhibited the increase in the blood dialysate vasopressin concentration and cardiodepressant activity elicited by an intra-arterial injection of hypertonic saline. These data indicate that excitatory amino acids are involved in the mechanism of increase in blood vasopressin and cardiodepressant factor concentration in response to osmotic stimulation. These results also demonstrate the utility of blood minidialysis for simultaneous monitoring of active substances concentration in the blood.