James L. Born

Heavy Particles, the Bragg Curve and Suppression of Pituitary Function in Diabetic Retinopathy

During the past six years heavy particles such as protons and alpha panticles were used to achieve partial or complete hypophysectomy in an attempt to slow down the progressivee, severe diabetic retinopathy in 71 patients. Pituitary suppression was indicated by fall in the insulin requirements and target-organ outputs of these patients. Sixty-one patients were followed long enough for reevaluation; the retinopathy had stabilized in 38 of these, and it was further noted that 14 of these 38 patients also showed improvement in visual acuity. The objective improvements observed in the appearance of the eye grounds were decreases in frequency of hemorrhages and microaneurysms and a decrease in neovascularization and exudates. Eleven patients had died: six with uremia, three of acute myocardial infarction, one of auricular fibrillation, and one of cardiovascular collapse. The findings indicate that retinopathy- can be favorably influenced by suppression or ablation of pituitary function, but it is felt that patients with advanced cardiovascular and renal complications are not desirable candidates. (auth)

Delayed sequelae of pituitary irradiaton

Since 1958, 781 patients at Lawrence Berkeley Laboratory have received helium-particle stereotactic radiosurgery to the adenohypophysis. Autopsy findings in 15 of these patients are reported. Ten patients received pituitary radiation (average dose, 116 Gy in six fractions) for progressive neovascularization retinopathy due to diabetes mellitus. Evidence of a time-dependent course of progressive fibrosis in their pituitary glands was found. Five patients were treated for eosinophilic adenomas. Although they had lower average doses of radiation (56 Gy in six fractions), their pituitary glands showed cystic cavitation of the adenomas. The adenomas thus appeared more radiosensitive than the normal pars anterior, which, in turn, was more radiosensitive than the adjacent neurohypophysis. No significant radiation changes were found in the surrounding brain or cranial nerves. The endocrine organs under pituitary control showed varying degrees of atrophy, and clinical tests revealed progressive hypofunction. It was concluded that charged-particle therapy produced a sharply delineated focal radiation lesion confined to the pituitary gland but did not cause injury to the critical structures of the surrounding central nervous system.

Heavy Particle Therapy in Acromegaly and Cushing's Disease.

A total of 349 patients with pituitary tumors, including acromegaly, Cushing disease, Nelson syndrome, prolactin-secreting adenoma, and chromophobe adenoma, have been treated with heavy-particle radiation during the past 17 years. The incidence of side effects has been low. Only 30 patients, 8.6%, have died, most of preexisting cardiovascular complications. Heavy particle therapy provides a form of treatment with no mortality and extremely low morbidity, and its use in treating pituitary disorders has resulted in dramatic improvement in the signs and symptoms of patients with acromegaly and Cushing disease.

HEAVY PARTICLES AND THE BRAGG PEAK IN THERAPY.

Excerpt It is indeed a pleasure and an honor to be asked to deliver a lecture honoring Dr. E. P. Richardson. He was our teacher during my third year of medical school and was in charge of bedside s...

Hypophysectomy with Nuclear Radiations

For many years, various investigators have attempted to influence the normal, neoplastic and hyperplastic pituitary gland in various experimental animals and in humans with various disease states by externally delivered irradiation [Crooke; Kelly et al.; Lawrence et al. (2); Rahm]. Due to the fact that conventional radiation, such as x-rays and gamma rays, produces so much scatter in tissues, it is highly questionable that pituitary function or histology ever has been influenced in the normal animal or in the so-called normal human pituitary with such externally delivered radiation.