Bertel Grahne

SERUM LIPIDS, POSTHEPARIN PLASMA LIPASE ACTIVITIES AND GLUCOSE TOLERANCE IN PATIENTS WITH PROLACTINOMA

Serum total cholesterol and triglyceride levels were determined in forty‐seven women with prolactinoma and in eighty‐four age‐ and weight‐matched control women. Oral glucose tolerance tests (OGTT) were performed and postheparin plasma lipoprotein lipase (LPL) and hepatic lipase (HL) activities were determined in twelve patients before and after transsphenoidal removal of the prolactinoma.

Recurrence of chromophobe pituitary adenomas after operation and postoperative radiotherapy

The rate of recurrence is reported in a prospective study of 56 patients (28 men, 28 women) with large chromophobe pituitary adenoma (with or without hyperprolactinemia). The surgical approach was transfrontal in 44 and transseptosphenoidal in 12 patients. Cryoapplication was combined with the transsphenoidal operation. All but one patient received post‐operative pituitary irradiation. Altogether, 11 (20 %) clinical relapses (10 men) occurred between 0.5 and 6 years after the transfrontal operation. Patients that relapsed had had larger tumors than those remaining in remission. Occurrence of the tumors appeared with a deterioration of the visual field defect in 9 patients. There were no differences in the degrees of hypopituitarism in patients who relapsed as compared to patients remaining in remission.

Long-term results after surgical treatment of laryngeal stenosis in small children

Thirteen severe cases of laryngeal stenosis were operated on at the ages of 1-3 years. The operations were performed by making a laryngofissure in the front part of the larynx and excising the stenosing scar. The back wall of the larynx was incised in the midline and the two halves of the cricoid lamina were separated from each other. An indwelling prosthesis was placed in the larynx for 4 months. All patients but one were decannulated. The positive clinical result of the operation proved to be permanent through the rapid growth phase of puberty in 7 patients out of the 10 who had reached puberty. Three patients developed a gradually worsening laryngeal stenosis during the rapid growth phase of puberty. One of them was successfully re-operated. The mean follow-up time was 12 years. Ventilatory function tests were performed on 9 patients, 4 of which proved to have normal ventilatory function or only slight airflow limitation in central airways.

PITUITARY FUNCTION IN PROLACTINOMA. EFFECT OF SURGERY AND POSTOPERATIVE BROMOCRIPTINE THERAPY

Forty‐five women and fifteen men with prolactinomas have been treated surgically. Patients with large tumours received pituitary irraditation and postoperative hyperprolactinaemia was treated with bromocriptine. The patients have been followed‐up for 6–36 months following the operation. The tumours were larger and the levels of production higher in men as compared with women. All women had amenorrhoea. Galactorrhoea was present in forty‐three women but not in the men. After surgery serum prolactin levels fell significantly in all women but remained above normal in thirty‐six; prolactin remained high in twelve men. Bromocriptine effectively decreased the postoperative hyperprolactinaemia. The surgical complications were oculomotor nerve paresis in one woman and one man. After surgery six (23%) women developed impaired GH secretion, six (15%) impaired thyroid function, eight (18%) impaired cortisol secretion and five (17%) impaired LH secretion in isolation or combination which had not been present preoperatively. Three patients relapsed.

TREATMENT OF ACROMEGALY BY TRANSSPHENOIDAL HYPOPHYSECTOMY WITH CRYOAPPLICATION

The therapeutic effect of transsphenoidal hypophysectomy with cryoapplication has been studied in twenty‐nine patients with active acromegaly. The mean follow‐up time was 15 months (3‐54 months).

WEgener's Granulomatosis

The authors describe the pathological picture in Wegeners granulomatosis and discLuss the etiology and pathogenesis of the disease. They report on four cases treated in Helsinki University Otolaryngological Hospital in 1964–65. The disease can be controlled to a high degree by adequate corticosteroid therapy. The authors point out, with special emphasis, that corticosteroid therapy must be initiated with large suppressive doses. They must be continued until definite healing of the granulating ulcerations is observed. Healing is accompanied by a normalization of the patients ESR. Subsequently the doses should be gradually lowered until a dose of maintenance level is reached, which in Wegeners granulomatosis varies from case to case and is frequently fairly high. If the maintenance dose is too low the symptoms recur soon, together with a rise in ESR.

Serous Otitis Media

Serous otitis media is arousing increasing interest among otologists, partly because the incidence of the disease seems to have grown and partly because its treatment in many cases affords difficult problems. If left untreated, it changes into chronic adhesive otitis and resultant severely impaired hearing. Treatment must be started before irreversible changes have occurred in the tympanum and the eustachian tube. Chronic cases of serous otitis media which are often refractory to all conventional therapy can be successfully treated by an indwelling plastic tube in the tympanum. The latent mastoiditis which frequently accompanies the condition must first be cured.

Laryngeal stenosis following papillomatosis--a report of three severe cases.

Three cases of severe laryngeal papillomatosis beginning in early childhood are presented. Several methods of treatment were tried, but lasting results were achieved by suction diathermy. The laryngeal lumen was totally obliterated in all cases during the course of the disease. The patients were successfully operated on by making a laryngofissure in the front part of the larynx, excising the scar and enlarging the lumen by a median incision in th back wall of the larynx. An indwelling prosthesis was placed in the larynx for several months. After removing the prosthesis, the laryngeal lumen was dilated several times by oesophageal sounds. All patients were successfully decannulated. The results of treatment are evaluated both clinically and by ventilatory function studies. Central airway obstruction persisted in two cases.

Inferior dacryocystorhinostomy in severe congenital dacryostenosis

Inferior dacryocystorhinostomy is a simple and effective method in the treatment of such cases of congenital dacryostenosis in which conservative treatment and probing have failed and in which the atresia is located at the level of the nasolacrimal duct. The operative technique is described in detail. The series treated by this method consists of 8 patients, 3 of whom showed bilateral stenosis. On 2 patients adenoidectomy was performed in connection with the dacryocystorhinostomy. The follow-up time ranged from 2 to 34 months, and a good result was obtained in 7 cases. In one case the passage produced closed soon after the operation. Endonasal dacryocystorhinostomy was then successfully carried out by Wests method. The operative technique described is well suited for patients under two years of age.

Growth Pattern of Meningeomas Penetrating the Skull Base

Three cases of intracranial meningeomas are presented as examples of tumours in which the extra-cranial growth formed a major otorhinolaryngological problem. The infiltrative growth pattern into the narrow lumina and bone channels of the otherwise histologically benign tumours is compared with findings in an experimental organ culture system, where a three-dimensional fibrin foam matrix formed the supporting structure with an interconnected network of lacunae. Of all intracranial tumours, meningeomas were the best growers in the system, and the clinical relevance of such growth characteristics demonstrated in vitro is pointed out in view of the resented cases.