Dynamic stereotactic radiosurgery: the Charleston program: a report on the first 150 patients.

We have been pleased with our initial experience in an evolving program. As newer surgical and radiotherapy techniques have become available, the role of radiosurgery has been and will continue to be modified. As more commercially available systems have been marketed, the availability will become more widespread. A battery of residents in neurosurgery and radiation oncology trained in these technologies will provide leadership and future directions of this therapy.

A study in post-Flexner survival. The Medical College of the State of South Carolina, 1913.

The Flexner report of 1910 resulted in the closing of many marginal medical schools and opened a new era in medical education in the United States. Caught in Abraham Flexner's net were several old schools with long histories and, as he said, "traditions and a certain present dignity" that lacked the minimum resources needed to meet the standards of the Council on Medical Education of the American Medical Association. One example was the Medical College of the State of South Carolina. It was consigned to oblivion in Flexner's plan, but survived. Dean Robert Wilson, MD, in his efforts to save his school, turned politician, enlisted the aid of the state's highly controversial governor, and initiated an effective lobbying campaign in the state legislature. The Council on Medical Education became involved unofficially in the person of its secretary, Nathan P. Colwell, MD. His presence in South Carolina was turned to advantage by Wilson and others and contributed substantially to the success of their efforts.

The man who killed Warrington Dawson.

On March 12, 1889, at about 4:00 p.m., the editor of the Charleston, South Carolina, News and Courier--Francis Warrington Dawson--was shot to death by Thomas Ballard McDow, M.D., a successful Charleston physician, in Dr. McDow's office. The investigation of the crime and the trial and acquittal of McDow have not been subjected to critical scrutiny in this century. This article offers an analysis of character and motivation of the principals, an examination of some of the evidence, a view of the prosecution and defense, and some conclusions based on these elements.

Stimulation of gonadotrophs by pituitary portal vessel infusion of superactive LH-RH analogues: an ultrastructural study.

LH-RH or its superactive analogues were infused into pituitary portal vessels of adult male rats for 1 min; pituitaries were then fixed for routine electron microscopy 1 min, 30 min and 3 h after infusion. A maximal increase of granule release at 2 min. and a maximal increase in synthetic activity (i.e., dilated cisternae of rough endoplasmic reticulum (RER) and Golgi apparatus (GA)) at 30 min, occurred in gonadotrophs in response to both LH-RH and the superactive analogues, but not to saline infusion. Only gonadotrophs from analogue infused pituitaries showed a high level of exocytosis and protein synthesis at 3 h. In addition, the superactive analogues typically stimulated formation of large vacuoles of RER at 30 min and 3 h that resembled those seen in "signet ring" cells following castration. Radioimmunoassay (RIA) values of serum LH supported these observations. The results of this study provide morphological evidence for a prolonged action of the superactive analogues of LH-RH on both gonadotropin secretion and synthesis under physiological conditions.

Ultrastructural observation of anterior pituitary gonadotrophs following hypophysial portal vessel infusion of luteinizing hormone-releasing hormone.

Luteinizing hormone-releasing hormone (LHRH) (50 ng) was infused with a microcannula into hypothalamo-hypophysial stalk portal vessels of adult male rats. Anterior pituitaries were prepared for electron microscopy at 1, 5, 10, 15, 30 and 60 minutes after infusion. Granule release (exocytosis) from gonadotrophs was stimulated within one minute. Evidence of increased protein synthesis began at 5-10 minutes but was not maximal until 15 minutes. The majority of new granules appeared in the Golgi apparatus at 15 and 30 minutes. This study provides morphological evidence for LHRH-induced hormone and synthesis release under physiological conditions.

An ultrastructural and radioimmunoassay study of anterior pituitary somatotrophs following pituitary portal vessel infusion of growth hormone releasing factor.

The hypophysial portal vessels and anterior pituitary glands of adult male rats were surgically exposed, cannulated and infused for 1 min with saline, growth hormone-releasing factor (GH-RF), and dbcAMP. After cessation of infusion, anterior pituitary glands were collected at 1, 5, 15, 30 or 60 min for electron microscopic and ultrastructural cytochemical examination. Before and after cannulation of a portal vessel a 1-ml sample of blood was collected at 1, 5, 15, 30 or 60 min from the femoral vein for RIA of growth hormone. When viewed ultrastructurally, the initial response following the infusion of GH-RF into a portal vessel was one of granule release. Emiocytic activity was observed at all time intervals studied. This response was followed 30 min later by evidence of increased protein synthesis. Significant increases in plasma GH levels were present at 1, 5, and 15 min following infusion of GH-RF but not at 30 or 60 min. Preliminary analysis of the RIA data suggests that dbcAMP was significantly more potent than GH-RF in elevating radioimmunoassayable plasma GH levels. The results suggest that similar mechanisms of synthesis and release were involved.

Pituitary growth hormone "synthesizing factor" in hypophysial portal blood.

Immunoreactive growth hormone (GH) released into an incubation medium and (14)C-leucine incorporation into GH by the anterior pituitary were determined after incubation for 15 min and one hr with hypophysial portal plasma and with peripheral plasma from the same animals as a control substance. Twenty-three hemipituitaries in which (14)C-leucine incorporation was measured at IS min showed a mean difference of 2,980 +/- 1,030 SEM cpm/mg of GH (t = 2.89, p < .01). After one hr of incubation no significant difference could be determined. After one hr of incubation the amount of GH released into the medium containing the portal plasma was significantly greater than the amount released into the medium containing peripheral plasma. The mean difference was 409 +/- 179 SEM ng/mg pituitary (* = 2.87, p < .05). After 15 min of incubation no differences in GH released into the medium could be detected. Differences in GH content of the pituitary could not be detected at either time period. The study supports the hypothesis that hypophysial portal plasma contains a factor which stimulates GH synthesis by the pituitary. In addition, the earlier finding of Wilber and Porter that the hypophysial portal plasma contains a factor which will release GH from the pituitary is confirmed.

The effects of hypophysial portal plasma on the content of immunoreactive growth hormone in the anterior pituitary.

1. Blood plasma obtained from the hypophysial portal vessels of rats has been tested in assay animals for effects on the content of growth hormone in the anterior pituitary.2. Growth hormone was estimated by radioimmuno-assay at 15 min, 30 min, 1 hr and 2 hr after intracarotid or intravenous infusion of portal plasma. There was a significant increase in growth hormone content at 15 min after infusion, but not at 30 min, 1 hr and 2 hr.3. Insulin, cold stress, haemorrhage and treatment with growth hormone had no effect on growth hormone content of the pituitary under the conditions of application of these stimuli.4. Growth hormone was measured in plasma obtained from the pituitary of control and insulin-treated animals. In control animals the amount of growth hormone in this plasma was higher than in base line samples and in the insulin-treated animals it was lower than in base line samples. A calculation based on the growth hormone content of blood obtained directly from the pituitary indicates a daily rate of synthesis and release of about 10 mug.5. The hypothesis that portal plasma stimulated the synthesis of immuno-assayable growth hormone by the anterior pituitary is considered.6. Discrepancies between our results using immuno-assay and those of others using bio-assay are discussed.

Demonstration of luteinizing hormone releasing factor in hypophysial portal blood of pro-oestrous & hypophysectomized rats.

1. A method for the routine collection of hypophysial portal blood from rats under direct vision has been described.2. This method has been used to obtain portal blood from adult female rats in pro-oestrus and adult female rats which had been hypophysectomized at least 14 days before collection.3. The pooled plasma from this blood was assayed for activity, resembling that of luteinizing hormone releasing factor (LRF), by the ovarian ascorbic acid depletion method.4. The portal plasma from both groups of donor animals exhibited significant activity when compared to peripheral plasma controls.5. It is concluded that the ovarian ascorbic acid depleting activity of portal plasma was due to LRF.6. The possibility that some of the activity exhibited by portal plasma from pro-oestrous rats was due to contamination of the samples by LH containing backflow blood from pituitary sinusoids is discussed.7. The possibility that the ovarian ascorbic acid depleting activity of the hypophysial portal plasma was due to either vasopressin or a nonspecific factor has been excluded.