Sagittal, T1-weighted, magnetic resonance imaging scans demonstrated a low-intensity band between the odontoid process and the body of the axis, which suggested a persistent cartilaginous band. Although upward migration of a herniated disc from the lower cervical spine and degeneration of retro-odontoid ligaments might be possible causes, a persistent cartilaginous band extending between the odontoid process and the body of the axis was considered to be the more likely origin of the retro-odontoid intervertebral disc hernia. Because the far-lateral surgical approach does not require retraction of the cervical cord and provides safe access to the lesion at the craniovertebral junction, it is a suitable surgical method for this condition.
Abstract. Somatostatin analogues such as octreotide are used to treat active acromegalic patients by reducing serum growth hormone (GH) levels. However, the acute effect of octreotide on GH secretion differs among patients. To elucidate factors influencing the acute effect of octreotide, we collected data from 56 patients with somatotroph adenoma from two institutions. We analyzed the correlation of the following factors with the acute effect of octreotide: immunohistochemical staining of somatostatin receptor subtype 2A (SSTR 2A), presence of gsp mutation, proliferative potentials analyzed by Ki-67 staining index (SI). We found that the acute effect of octreotide significantly correlated with two factors: Ki-67 SI and the plasma membrane-dominant staining pattern of SSTR 2A. Monovariate analysis revealed a statistically significant inverse relation of Ki-67 SI with the reduction of GH by octreotide. We assessed the contribution of each factor on the acute effect of octreotide by multivariate analysis. Significant multiple regression was confirmed with p value of 0.003. Post-test revealed that the plasma membrane-dominant staining pattern of SSTR 2A was significantly related to the reduction of GH by octreotide. These results show that the acute effect of octreotide is positively related to SSTR 2A staining on the plasma membrane.Key words: Somatostatin receptor type 2A, Ki-67 staining index, Gsp mutation, Octreotide, GH-secreting adenoma (Endocrine Journal 56: 295-304, 2009) TRANSSPHENOIDAL surgery is the first-line therapy for acromegaly. However, at least one-third of the patients with active somatotroph adenoma are not cured by surgery alone. Additional medical or radiological therapy has been used for postoperative patients who do not achieve remission. Somatostatin analogues including octreotide are applied to active acromegalic patients in order to normalize serum growth hormone (GH) secretion and insulin-like growth factor (IGF)-1 levels. However, the acute effect of octreotide on GH secretion differs among patients. There are several factors known to influence the acute effect of octreotide on GH secretion. First, immunostaining of somatostatin receptor on the plasma membrane influences the outcome of the octreotide treatment [1][2][3][4]. Secondly, tumors with the gsp mutation [5][6][7] display a better sensitivity to somatostatin, although some studies report the reverse result. Gsp mutation that is present in about 40% of somatotrophs adenomas could be a marker of the susceptibility of the tumor to octreotide [8,9]. Meanwhile, the proliferative potential of the tumor is an important feature influencing the biological activity of the adenoma and may influence the acute effect of octreotide. Ki-67 immunostaining is an established method to assess the proliferative potential. However, the contribution of the proliferative potential on the acute effect of octreotide and the mutual relationship among these factors have not been evaluated.In this study, we evaluated the contribution and mutual relations...
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