ObjectiveTranssphenoidal surgery (TSS) presents the treatment of choice for Cushing's disease (CD). Remission and recurrence rates vary dependent on tumor size, extension, adenoma visibility on ...magnetic resonance imaging, and neurosurgical expertise. Other than published from single-surgeon neurosurgical series so far, we have aimed to describe long-term remission and recurrence rates of CD in a series incorporating different neurosurgeons, trying to reflect care reality in the Munich Metropolitan Region, which is accommodated by three tertiary university and multiple, smaller neurosurgical centers.DesignWe conducted a retrospective analysis of 120 patients who underwent first and 36 patients who underwent second TSS as treatment for CD between 1990 and 2012.MethodsPatients were divided into three groups according to remission status. Potential risk factors for recurrence, pituitary function, and strategy in persistent disease were assessed.ResultsThree outcome groups were identified according to remission status after first TSS (mean follow-up 79 months): remission, 71% (85/120), disease persistence, 29% (35/120), and disease recurrence, 34% (29/85) (mean time to recurrence 54 months). After second TSS (n=36, mean follow-up 62 months), we documented remission in 42% (15/36), disease persistence in 58% (21/36), and disease recurrence in 40% (6/15) (mean time to recurrence 42 months). Postoperative hypocortisolism after first, though not after second, TSS was associated with a lower risk of suffering disease recurrence (risk=0.72; 95% CI 0.60–0.88; exact significance (two-sided) P=0.035).ConclusionsOur study shows higher recurrence rates of CD after first TSS than previously reported. Second TSS leads an additional 8% of the patients to long-term CD remission.
Abstract
We have tested operation of FAIR’s low-energy ion storage ring CRYRING@ESR with uncompensated electron cooler solenoid. With its standard working point on the lowest-order difference ...resonance, a second solenoid is normally used to cancel betatron coupling introduced by the cooler’s magnetic field. In operation with a D
+
test beam, we found that omission of the compensation solenoid did not lead to a notable deterioration of beam intensity, quality, or cooling time, though the expected coupling of betatron motion is then clearly observed.
Abstract
The matter radius of the doubly magic
$$^{56}$$
56
Ni was extracted from a measurement of the differential cross section by employing, for the first time, elastic proton scattering in ...inverse kinematics with a radioactive beam at
$$E_{kin}=390.2$$
E
kin
=
390.2
MeV/nucleon circulating in a storage ring and passing an internal hydrogen gas-jet target with a revolution frequency of around 2 MHz. The novel experimental scheme is based on UHV-compatible Si detectors operated as active vacuum windows, which were implemented in the ESR storage ring at GSI. A matter radius
$$<r_{m}^{2}>^{1/2}=3.74^{+0.03}_{-0.06}$$
<
r
m
2
>
1
/
2
=
3
.
74
-
0.06
+
0.03
fm was extracted for the doubly-magic self-conjugate nucleus
$$^{56}$$
56
Ni.
A new technique developed for measuring nuclear reactions at low momentum transfer with stored beams in inverse kinematics was successfully used to study isoscalar giant resonances. The experiment ...was carried out at the experimental heavy-ion storage ring (ESR) at the GSI facility using a stored 58Ni beam at 100 MeV/u and an internal helium gas-jet target. In these measurements, inelastically scattered α-recoils at very forward center-of-mass angles (θcm≤1.5°) were detected with a dedicated setup, including ultra-high vacuum compatible detectors. Experimental results indicate a dominant contribution of the isoscalar giant monopole resonance at this very forward angular range. It was found that the monopole contribution exhausts 79−11+12% of the energy-weighted sum rule (EWSR), which agrees with measurements performed in normal kinematics. This opens up the opportunity to investigate the giant resonances in a large domain of unstable and exotic nuclei in the near future. It is a fundamental milestone towards new nuclear reaction studies with stored ion beams.
ObjectiveClinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the ...clinical characteristics of pain in a large cohort of patients with pituitary disease.DesignIn a cross-sectional study, we assessed 278 patients with pituitary disease (n=81 acromegaly; n=45 Cushing's disease; n=92 prolactinoma; n=60 non-functioning pituitary adenoma).MethodsPain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL).ResultsWe recorded a high prevalence of bodily pain (n=180, 65%) and headache (n=178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (n=34, 76%). Headache was equally frequent in patients with macro- and microadenomas (68 vs 60%; P=0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (n=193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL.ConclusionsPain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL.
Chronic hypercortisolism in Cushing's disease (CD) has been suggested to contribute to an altered personality profile in these patients. We aimed to test this hypothesis and attempted to determine ...the effects of disease- and treatment-related factors that might moderate an altered personality in CD.
We assessed 50 patients with CD (74% biochemically controlled) and compared them to 60 patients with non-functioning pituitary adenomas (NFPA) and 100 age- and gender-matched mentally healthy controls. Personality was measured by two standardized personality questionnaires, TPQ (Cloninger personality questionnaire) and EPQ-RK (Eysenck personality questionnaire-RK).
Compared to mentally healthy controls, CD patients reported significantly less novelty-seeking behaviour, including less exploratory excitability and less extravagance. On harm avoidant subscales, they presented with more anticipatory worries and pessimism, higher fear of uncertainty, shyness with strangers, fatigability and asthenia. Moreover, CD patients appeared to be less extraverted, more neurotic and socially desirable. CD patients differed from NFPA patients in terms of higher neuroticism scores, and NFPA patients did not show altered novelty-seeking behaviour or extraversion. In the subgroup analysis, CD patients with persistent hypercortisolism displayed significantly higher fear of uncertainty, fatigability and asthenia, indicating high harm avoidance in total, than those in biochemical remission.
Patients with CD showed a distinct pattern of personality traits associated with high anxiety in combination with traits of low externalizing behaviour. Such personality changes should be taken into account in the diagnosis and treatment of CD patients, as they might interfere with the patient-physician communication and/or challenge the patients' social and psychological functioning.
ObjectiveAlthough neuropsychiatric and morphological brain alterations in acromegalic patients have been described and a distinct disease personality is clinically suspected, this has never been ...systematically investigated. We examined whether patients with acromegaly showed an altered personality profile compared with patients with non-functioning pituitary adenomas and healthy controls.Design and methodsIn this cross-sectional study, 70 acromegalic patients and 58 patients with non-functioning pituitary adenomas were compared with 140 mentally healthy population controls, matched for age and gender. Personality traits were measured by standardized personality questionnaires (Eysenck personality questionnaire-RK and tridimensional personality questionnaire).ResultsCompared with healthy controls, acromegalic patients described themselves as distinctly more harm avoidant and neurotic and presented themselves with high social conformity. On harm avoidant subscales, they reported more anticipatory worries and pessimism, higher fear of uncertainty, higher fatigability and asthenia. This personality pattern was not specific for acromegaly, but could similarly be observed in patients with non-functioning pituitary adenomas. However, specific for patients with GH-producing adenomas was an even more reduced novelty-seeking behaviour, especially in terms of lower impulsiveness, compared with patients with non-functioning pituitary adenomas.ConclusionPatients with pituitary adenomas show a distinct pattern of increased anxiety-related personality traits compared with the general population, potentially as a result of the pituitary lesion and/or associated hormonal dysregulations and comorbidities. Acromegaly is additionally associated with reduced impulsivity and novelty-seeking behaviour, which might affect patients' management and their quality of life.
An optical technique to study the longitudinal distribution of ions in a bunched ion beam circulating in a storage ring is presented. It is based on the arrival-time analysis of photons emitted after ...collisional excitation of residual gas molecules. The beam-induced fluorescence was investigated in the ultraviolet regime with a channeltron and in the visible region using a photomultiplier tube. Both were applied to investigate the longitudinal shape of bunched and electron-cooled 209Bi80+ ion beams at about 400MeV/u in the experimental storage ring (ESR) at GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt, Germany. Bunch lengths were determined with an uncertainty of about 0.5m using the UV-sensitive channeltron and with slightly lower accuracy from the photomultiplier data due to the slower transitions in the red region of the spectrum. The Gaussian shape of the longitudinal distribution of ions inside the bunch was confirmed. With the information of the transverse beam size that can be measured simultaneously by a newly installed ionization profile monitor (IPM) at the ESR, an accurate determination of the ion density in the bunched beam will be allowed.
► Optical methods to measure the bunch shape of ion beam at storage ring. ► High resolution of bunch length was obtained from the UV-sensitive channeltron. ► The Gaussian shape of longitudinal distribution of the ions in the bunch was confirmed.
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