ABSTRACT
Fourteen patients with Cushing's disease treated by trans-sphenoidal hypophysectomy between 1962 and 1975 were reviewed in 1983. Complete ablation had been attempted. There were no surgical deaths and one episode of bacterial meningitis. Two patients required a second operation for a cerebrospinal fluid leak. There have been three late deaths from unrelated causes. All patients had a biochemical remission of their Cushing's disease postoperatively and no relapse has been recorded. Most patients need some hormone replacement but residual pituitary function and sella radiography have remained stable. This treatment seems satisfactory and the evidence implies a pituitary aetiology of the syndrome.
Subject(s)
Cushing Syndrome/surgery , Hypophysectomy , Adult , Cushing Syndrome/blood , Female , Follow-Up Studies , Hormones/blood , Humans , Male , Middle Aged , Postoperative PeriodABSTRACT
Twenty-five patients with dysphagia caused by neurological disorders, mainly motor heurone disease, underwent cricopharyngeal myotomy. Nineteen patients showed slight to dramatic improvement of swallowing for variable periods of time. There were five postoperative deaths. The results indicate that this simple procedure is of benefit to a substantial proportion of patients with neurological causes of dysphagia.
Subject(s)
Cricoid Cartilage/surgery , Laryngeal Cartilages/surgery , Motor Neurons/surgery , Neuromuscular Diseases/surgery , Pharynx/surgery , Adult , Aged , Aphasia/surgery , Female , Humans , Male , Middle Aged , Postoperative Complications/mortalityABSTRACT
Thirteen patients aged 24 to 65 with Cushing's disease have been treated by transphenoidal hypophysectomy. There was one incident of meningitis and one late death from myocarditis. No radiotherapy was given. In 12 patients pituitary histology showed Crooke's changes and an adenoma was present in seven. On review of the 12 survivors two to 11 years later, 11 are in complete remission. One patient still showed some clinical features of Cushing's syndrome but steroid levels were normal. In five of the seven premenopausal women normal menstruation has returned and pregnancy has occurred in three. In four patients replacement hormone therapy is no longer required and a further four take only partial treatment. We conclude that transphenoidal hypophysectomy is an effective treatment for Cushing's disease.
Subject(s)
Cushing Syndrome/therapy , Hypophysectomy , Adrenal Cortex Function Tests , Adult , Aged , Cushing Syndrome/physiopathology , Female , Growth Hormone/blood , Humans , Male , Middle Aged , Pituitary Function Tests , Pituitary Gland/physiopathology , Thyroid Function TestsABSTRACT
One hundred and eight patients with advanced carcinoma of the breast were treated by trans-sphenoidal hypophysectomy and followed up for at least 1 year. The results were assessed both by clinical response and objectively by survival following hypophysectomy, as expressed by the survival ratio. The two methods showed close correlation. The results show that there is a variation in response relating to menopausal status and age at diagnosis, subsequent hormonal manipulaton and physical condition at hypophysectomy. Younger patients whose carcinoma is diagnosed after menopause carry a good prognosis, yet the older premenopausal patients, especially if their clinical condition is poor, do not benefit. Easily available clinical information can be a guide to prognosis.
