Bronson S. Ray

Hypophysectomy in the treatment of metastatic mammary cancer

Abstract The results of hypophysectomy in 343 patients with metastatic cancer of the breast are presented. These results indicate that hypophysectomy is a practical, worthwhile therapeutic procedure to be recommended in the management of these patients. Certain factors which influence the response to hypophysectomy are discussed. The most reliable index for predicting a favorable response to hypophysectomy is a previous favorable response to oophorectomy in the premenopausal patient. Other factors, such as the response to hormone therapy, the duration of the cancer, the age of the patient, and the location and extent of metastases have some influence on the incidence of remissions, but are not particularly helpful in deciding on therapy for the individual patient. Hypophysectomy is recommended as the initial systemic treatment of choice in postmenopausal patients and in those who have had a previous favorable response from oophorectomy, when adequate facilities are available to perform this procedure.

Glossopharyngeal neuralgia; a cause of cardiac arrest.

Abstract Glossopharyngeal tic douloureux or neuralgia is a comparatively rare but well-recognized syndrome. In respect to the stabbing paroxysmal nature of the pain and its relation to specific trigger zones, it is exactly comparable to the commoner trigeminal tic douloureux. In neurosurgical clinics the two types of neuralgia occur in a ratio of about one to forty. The significance of cardiac arrest and syncope associated with glossopharyngeal neuralgia was first emphasized by Riley and associates, 1 in a brief report of two cases in 1942. This report called attention to the afferent pathway of the carotid sinus reflex through the glossopharyngeal nerve and suggested the correlation of the simultaneous neuralgia and excessive stimuli to the sinus reflex. Neither of the two cases was reported to have been subjected to operation. Since then, no other reports of similar cases have come to light in medical literature. However, one of us (Ray) had the opportunity of examining such a case with Dr. Jefferson Browder in 1943 and this patient was relieved of all symptoms by intracranial section of the glossopharyngeal nerve. Because of the importance of further establishing the authenticity of the syndrome and calling wider attention to the importance of its recognition, there is justification for reporting another comparable case.

Dural sinus venography.

Cerebral Angiography by the injection of contrast medium into the carotid or vertebral arteries provides an adequate and dependable method for the demonstration of the intracranial arterial system. As a result of many detailed studies, the variations of the arterial system of the brain both in the normal and in the diseased state are now well established. On the other hand, studies of the cerebral veins and dural sinuses are few, and their normal and pathological variations are generally unknown. While roentgenograms taken in the so-called venous phase after injection of a contrast medium via the arterial route may demonstrate some of the cerebral veins and sinuses, visualization is often incomplete and difficult to interpret. In an attempt to demonstrate the intracranial venous system more satisfactorily, we have employed several methods of investigation, including (1) direct injection of a contrast medium through a catheter introduced into the anterior third of the superior sagittal sinus; (2) retrograd...

SURGICAL EXPERIENCE WITH CHROMOPHOBE ADENOMAS OF THE PITUITARY GLAND

Between 1950 and 1969, 165 operations were performed on 146 patients for the treatment of chromophobe adenoma of the pituitary gland unassociated with either acromegaly or Cushings syndrome. The over-all operative mortality was 1.2%, and no deaths occurred in 138 cases operated on for the first time. In 106 of the patients who had not received prior treatment, vision was improved in 80% of eases and returned to normal in 50%. In the group of patients whose initial treatment was surgery, postoperative radiation therapy was administered in one-half of the cases. The rate of recurrence was 8 % in those who received radiation and 22% in those who did not. Recurrence of symptoms within less than 1 year often was due to a hemorrhagic cyst which could be treated better by reoperation than by radiation therapy.

Shock: pathogenesis and therapy.

This report of the international symposium on shock, held in Stockholm in June, 1961, is made up of 31 presentations followed by discussions. There were 41 participants, a number of whom were from related fields. The papers of Rushmer and Fine both stress the urgency of differentiating between reversible and irreversible shock. L.-E. Gelin underlines the importance of differentiating between neurogenic shock, acute hemorrhagic shock, traumatic and toxic shock, especially in fluid-substitution therapy. Six papers deal with the cardiovascular events in shock. The role played by the kidney, though obvious, is illuminated by some new and interesting information. Endocrine functions, blood volume, blood aggregation and viscosity are factors whose importance is becoming increasingly apparent. Several papers referring to the occurrence and development of acidosis elucidate biochemical events in shock, and several participants stress the significance of the toxins and endotoxins. Convincing proof is afforded of the importance of preventing irreversible