G.F. Joplin

An assessment of radiological criteria used in the study of spinal osteoporosis.

Abstract Lateral radiographs of the thoracic and lumbar spine of 34 patients with spinal osteoporosis were taken at intervals of six months for a period of at least two years. The radiographs were carefully reviewed to assess the effects of treatment with calcium supplements and/or anabolic compounds. In particular, attempts were made to assess the photographic density of the vertebral bodies relative to that of the soft tissues, the relative prominence of vertical trabeculae, the thickness of the anterior cortex of the vertebral bodies, the thickness and photographic density of the end-plates, and the degree of biconcavity of the 3rd lumbar vertebra. None of these methods proved reliable.

Partial Pituitary Ablation with Implants of Gold-198 and Yttrium-90 for Acromegaly

The ideal method for the treatment of acromegaly remains uncertain. Evidence of local pressure from a pituitary tumour offers an absolute indication for treatment, and this has usually been surgical decompression ; however, when treatment has been given by external deep x-ray therapy the majority of such patients have shown improvement in their visual-field defects (Fraser and Joplin, 1961). Where the presenting syndrome comprises only acromegaly and the other effects of excessive growth-hormone secretion the need for treatment may seem less obvious. The activity of acromegaly is difficult to assess, and the natural history of the untreated disease is not adequately known. Bishop and Briggs (1958) reported that 80 % of their patients had died by the age of 60 predominantly from cardiovascular complications, but this high mortality rate awaits confirmation. Acromegaly without symptoms of a pituitary tumour has often been left untreated ; however, we have implanted such cases as well as those with tumour signs or symptoms, so long as no evidence was found of any considerable extrasellar extension.

Partial pituitary ablation with implants of gold-198 and yttrium-90 for Cushing's syndrome with associated adrenal hyperplasia.

There is still considerable controversy over the best method of treating Cushings syndrome when it is due to bilateral adrenal hyperplasia. The majority of such patients are treated by either total or subtotal adrenalectomy. These, however, are not only major operations but they often lead to a lifelong dependence on corticosteroids, and are sometimes followed by progression of a pituitary tumour which requires further treat ment (Sprague et al., 1961). Some remission has also been reported in about half of the patients given conventional deep ?-ray therapy to the pituitary (Dohan et al., 1957 ; Soffer et al., 1961), and more often when this was supplemented by uni lateral adrenalectomy (Soffer et al., 1961). In the hope of obtaining good responses more often from a higher irradiation dose to the pituitary, we have treated our patients for the past five years by partial pituitary ablation by means of implantation of radioactive material into the pituitary. . This allows the delivery of a greater dose of irradiation to the pituitary than is possible by external deep *-ray therapy, yet without incurring extra risk of damage to the surrounding structures. Satisfactory results from more intensive radio therapy to the pituitary have also been reported by Linfoot et al. (1963), using heavy-particle beams, and by Molinatti et al. (1960), also using 90Y implants. This paper supplements our previous communication (Joplin et al., 1961), and also reviews the diagnostic procedures which can be used to establish the diagnosis.

Barbiturate Antagonists to Shorten Drowsiness after Sedated B.M.R. Determinations

A study is described of the part played by the umbilical cord of the newborn infant as a source of infection in a maternity hospital. The cords of one group of babies were treated with triple dye. Nasal and skin swabs were compared with those of an untreated group in another unit and counts made of Staph. aureus colonies on settling-plates put down in the two nurseries. After a fortnight, treatment was introduced into the unit which had previously acted as a control, and similar investigations were carried out. There was a significant difference between the treated and untreated groups in respect of both the nasal and skin swabs and the numbers of Staph. aureus colonies isolated from settling plates. In a second investigation, treated and untreated babies were kept together in the same nursery. Skin swabs again showed a significant difference, but the nasal infection rates were the same in both groups. The practical value of these findings is discussed in relation to the prevention of cross-infection among newborn infants.