ABSTRACT
The authors report the results of a study designed to compare the effectiveness of two different types of radiation in patients with acromegaly where surgical therapy had failed to normalize growth hormone (GH). Longterm follow-up after conventional high voltage radiation in 17 patients and proton therapy in 13 patients confirmed a similar reduction of GH levels in both groups. After 4.5 years a decrease of about 80% was achieved. After "conventional radiation" GH was normal in 8 (47%) and near normal in 6 (35%) while proton therapy resulted in normalization in 5 and improvement in 5 (38%). The slightly better results of "conventional radiation" must be attributed to lower pretreatment levels of GH. Side effects as additional pituitary deficits and oculomotor palsies were more often seen after proton treatment. Since the results of both radiation methods are similar and proton therapy has a tendency to more serious side effects we recommend "conventional radiation" as secondary treatment of acromegaly.
Subject(s)
Acromegaly/surgery , Adenoma, Acidophil/radiotherapy , Cobalt Radioisotopes/therapeutic use , Pituitary Neoplasms/radiotherapy , Protons , Radioisotope Teletherapy , Acromegaly/blood , Acromegaly/radiotherapy , Adenoma, Acidophil/blood , Adenoma, Acidophil/surgery , Adult , Combined Modality Therapy , Follow-Up Studies , Growth Hormone/blood , Humans , Pituitary Gland, Anterior/surgery , Pituitary Neoplasms/blood , Pituitary Neoplasms/surgeryABSTRACT
In 100 consecutive transnasal sellar explorations in suspected Cushing's disease, 88 pituitary adenomas were removed. The initial remission rate in adenoma cases was about 90%. Complications related to surgery had been rare. Regularly after complete selective adenomectomy a period of ACTH and cortisol deficiency was found (90%). In these patients only 1 recurrence was seen whereas from 5 patients without cortisol deficit a relapse occurred in 4. Hypertension was found in 80% of patients with verified Cushing's disease. With normalization of cortisol excess, hypertension disappeared in 75% and was ameliorated in 15%.
Subject(s)
ACTH Syndrome, Ectopic/surgery , Adenoma/surgery , Cushing Syndrome/surgery , Hypertension/surgery , Paraneoplastic Endocrine Syndromes/surgery , Pituitary Neoplasms/surgery , Blood Pressure , Humans , Hydrocortisone/blood , Microsurgery , ReoperationABSTRACT
The different reasons for perforations of the oesophagus are listed with their preferential locations. A survey is given on the necessary x-ray diagnostics including computed tomography according to the clinical signs. Examples of the characteristic x-ray findings and follow-up are demonstrated with their relation to the surgical possibilities.
Subject(s)
Esophageal Perforation , Adult , Aged , Carcinoma, Squamous Cell/surgery , Drainage , Esophageal Fistula/etiology , Esophageal Neoplasms/surgery , Esophageal Perforation/complications , Esophageal Perforation/pathology , Esophageal Perforation/surgery , Female , Humans , Iatrogenic Disease , Intubation/adverse effects , Male , Mediastinitis/etiology , Mediastinitis/therapy , Middle Aged , Tomography, X-Ray Computed , Tracheoesophageal Fistula/diagnostic imagingABSTRACT
With the help of three arguments which come from the data analysis of a special consulting hour is demonstrated the ascents of germs into the prevesical urinary tracts in female patients with relapsing, non-obstructive urinary infections not in the least in every case lead to a recognizable lesion of the kidney. The thesis is erected that the generally tabooed pyelitis by all means corresponds to a clinical reality. This thesis is discussed in the light of findings from animal experiments and clinical findings from literature.
