No abstract

Objectives-Two case studies are reported of patients with pituitary adenomas who had been treated with trans-sphenoidal surgery, one with and one without adjunctive radiotherapy, in whom memory impairment was found. Further to this, neuropsychological investigations of 90 patients were carried out (1) to establish the prevalence of such deficits, and (2) to try to determine their cause. Methods-Two case studies are described. For the expanded study, patients were recruited from the data base of the endocrinology department of St Thomas's Hospital, London, if they had previously been treated for a pituitary adenoma in the past 30 years. Ninety patients were contacted and assessed with a wide range of neuropsychological tests. They were divided into five treatment groups: those who had received transfrontal surgery with radiotherapy, trans-sphenoidal surgery with or without radiotherapy, radiotherapy only, and a bromocriptine therapy group, as well as a group of 19 healthy control subjects matched for age and sex. Results-In the two patients presented, both showed severe memory impairments compared with their intact intellectual ability. The more severely aVected patient had received adjunctive radiotherapy, and superimposition of the 90% isodose fields on a postoperative MRI examination suggested involvement of the diencephalic structures. In the group study, significant deficits in anterograde memory were also obtained on two measures (WMS-R, RMT) for all patient groups when compared with the healthy controls, although these impairments varied in degree and were less in the bromocriptine group. However, the individual surgical and radiotherapy treatment groups did not differ significantly from one another. By contrast, general intellectual function (IQ) remained intact for all groups, as did performance on supplementary cognitive tests, including measures of frontal lobe or "executive" function, language comprehension, and speed of mental processing. Psychiatric morbidity and tumour aetiology did not seem to relate to the presence of memory deficits. Conclusions-Anterograde memory deficits were seen in the two case studies and in all our treatment groups when compared with the healthy controls, and these occurred in the context of preserved intellectual function. The present findings suggest that these memory deficits result from treatment rather than from the underlying tumour, but there was no diVerence between the eVects of surgery and radiotherapy. It is suggested that they result from damage to diencephalic structures implicated in memory. (J Neurol Neurosurg Psychiatry 1998;65:870-876) Keywords: pituitary tumours; memory impairments; radiotherapy; surgery Pituitary adenomas account for about 10% of intracranial tumours and, although nearly always benign in nature, usually require treatment to alleviate pressure eVects and hormone hypersecretion. Many structures adjacent to the pituitary are known to be important for normal memory processing and are, therefore, at risk of incidental damage from t...

A high-fat diet in pregnancy led to vascular dysfunction in rat weanlings and young adult offspring. Vascular function further deteriorated in weanlings if the maternal rat was diabetic.

SummaryThe aim of this study was to determine whether permitting women in labour to eat a light diet would: (i) alter their metabolic profile, (ii) influence the outcome of labour, and (iii) increase residual gastric volume and consequent risk of pulmonary aspiration. Women were randomised to receive either a light diet (eating group, n ¼ 48) or water only (starved group, n ¼ 46) during labour. The light diet prevented the rise in plasma b-hydroxybutyrate (p ¼ 2.3 × 10 ¹5 ) and nonesterified fatty acids (p ¼ 9.3 × 10 ¹7 ) seen in the starved group. Plasma glucose (p ¼ 0.003) and insulin (p ¼ 0.017) rose in the eating group but there was no difference in plasma lactate (p ¼ 0.167) between the groups. There were no differences between the groups with respect to duration of first or second stage of labour, oxytocin requirements, mode of delivery, Apgar scores or umbilical artery and venous blood samples. Relative gastric volumes estimated by ultrasound measurement of gastric antral cross-sectional area were larger (p ¼ 0.001) in the eating group. This was supported by the observation that those from this group who vomited, vomited significantly larger volumes than those in the starved group (p ¼ 0.001). We conclude that eating in labour prevents the development of ketosis but significantly increases residual gastric volume.

.0], P < 0.01). In the presence of indomethacin relaxation to acetylcholine was similar in both groups suggesting a deficiency in dilator rostaglandin synthesis in further reduced sensitivity of arteries to acetylcholine but to a similar degree in both normal pregnant and gestational diabetic women. Relaxation to sodium nitroprusside, an indicator of sensitivity of the vascular smooth muscle to nitric oxide, was similar in both groups.Conclusions Maternal vascular endothelial dysfunction may contribute to the increased incidence of cardiovascular disorders in women with gestational diabetes.the arteries from the diabetic women. The nitric oxide synthase inhibitor N E -monomethyl-L-arginine