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Archives of Otolaryngology

Publisher:
American Medical Association
American Medical Association
ISSN:
0003-9977
Scimago Journal Rank:
136
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Living on the Firing Line

ROTH, J. REESE

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050245001pmid: 6034650

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract THE increasing level of noise to which the general public is exposed has been a matter of growing concern. This encroachment on the public sensibilities has been so gradual and widespread that little opportunity has presented itself for the large-scale practice of preventive medicine in this field. If present plans with respect to the proposed supersonic transport plane (SST) are carried out, the public will be exposed to a quantum increase in the level of unwanted noise and irritation. If placed into regular passenger service, these planes can inflict those living near airports with noise much louder and more widely spread than that associated with conventional jets. Potentially much worse, however, is their sonic boom, to which everyone under their flight paths will be exposed. The sonic boom is a momentary, startling pressure disturbance, produced whenever an aircraft flies faster than the speed of sound, and it reaches the ground
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Anatomical Considerations in Transsphenoidal Hypophysectomy

Willson, John T.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050247002pmid: 6034651

Abstract SINCE the turn of the century surgeons have proposed many procedures for exposure of the hypophysis cerebri. Of the operations proposed, two principal routes have been selected to reach the hypophysis, first the intracranial and second, the extracranial or transsphenoidal.1-5 By whatever method the operation is performed, it is evident that one must have not only an accurate anatomical knowledge of the region involved but also an acquaintance with any marked variations from the usual type which might be encountered. The hypophysis, or pituitary gland, is a small gland of dual origin. The adenohypophysis is derived from ectoderm of Rathke's pouch of the stomodeum. The neurohypophysis is derived from the neural ectoderm of the floor of the diencephalon. The neurohyphysis consists of three parts: the median eminence of the tuber cinereum; the infundibular stem; and the infundibular process or pars nervosa or posterior lobe of the older terminology. The References 1. Cushing, H.: The Pituitary and Its Disorders , Philadelphia: J.B. Lippincott Co., 1912, pp 295-301. 2. Green, H.T.: The Venous Drainage of the Human Hypophysis Cerebri , Amer J Anat 100:435-470, 1957.Crossref 3. Halstead, A.E.: Remarks on the Operative Treatment of Tumors of the Hypophysis: Report of Two Cases Operated on by an Oro-nasal Method , Surg Gynec Obstet 10:494-502, 1910. 4. Harris, G.W.: Neural Control of the Pituitary Gland , Baltimore: The Williams and Willkins Co., 1955. 5. Hirsch, O.: Symptoms and Treatment of Pituitary Tumors , Arch Otolaryng 55:268-306, 1952.Crossref 6. Schaeffer, J.P.: Some Points in the Regional Anatomy of the Optic Pathway, With Especial Reference to Tumors of the Hypophysis Cerebri and Resulting Ocular Changes , Anat Rec 28:243-279, 1924.Crossref 7. Wislocki, G.B.: The Meningeal Relations of the Hypophysis Cerebri: II. An Embryological Study of the Meninges and Blood Vessels of the Human Hypophysis , Amer J Anat 61:95-117, 1937.Crossref 8. Brander, J.: The Intraglandular Cleft of the Pituitary Body and Its Connections , J Anat 66:202-209 ( (Jan) ) 1931. 9. Wislocki, G.B.: The Meningeal Relations of the Hypophysis Cerebri: I. The Relations in Adult Mammals , Anat Rec 67:273-293, 1937.Crossref 10. Schwartz, H.G.: The Meningeal Relations of the Hypophysis Cerebri , Anat Rec 67:35-51, 1936.Crossref 11. Romeic, B.: in Mollendorff, W.V. (ed.): Handbuch Der Mikroskopischen Anatomie des Menschen , Berlin: Verlag von Julius Springer, 1940, VI-3: 48-64. 12. Fisher, C.; Ingram, W.R.; and Ranson, S.W.: Diabetes Insipidus and Neurohormonal Control of Water Balance Ann Arbor, Mich: Edwards Bros Inc., 1938. 13. McConnell, E.M.: The Arterial Blood Supply of the Human Hypophysis Cerebri , Anat Rec 115:175-203, 1953.Crossref 14. Stanfield, J.P.: The Blood Supply of the Human Pituitary Gland , J Anat 94:257-273, 1960. 15. Xuereb, G.P.; Prichard, M.M.L.; and Daniel, P.M.: (1) The Arterial Supply and Venous Drainage of the Human Hypophysis Cerebri, (2) The Hypophyseal Portal System of Vessels in Man , Quart J Exp Phys 39:199-218, 219-227, 1954. 16. Dixon, F.W.: A Comparative Study of the Sphenoid Sinus , Ann Otol 46:687-698, 1937. 17. Gibson, S.W.: The Topography of the Hypophysis Cerebri , Surg Gynec Obstet 15:199-205, 1912. 18. Hammer, G., and Radberg, C.: The Sphenoidal Sinus: An Anatomical and Roentgenologic Study With Reference to Transphenoid hypophysectomy , Acta Radiol 56:401-422, 1961.Crossref 19. Negus, V.: The Comparative Anatomy and Physiology of the Nose and Paranasal Sinuses , London: E. and S. Livingstone Ltd., 1958. 20. Peele, J.C.: Unusual Anatomical Variations of the Sphenoid Sinuses , Laryngoscope 67:208-237, 1957. 21. Diamant, M.: Hypophysectomy in a Nonpneumatized Sphenoid , Arch Otolaryng 74:9-10, 1961.Crossref 22. Hamberger, C.A., et al: Transantrosphenoidal Hypophysectomy , Arch Otolaryng 74:22-28, 1961.Crossref 23. Ezrin, C.: The Pituitary Gland , Clin Sympos 15:71-100 ( (July) -Sept) 1963.
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Transseptal Transsphenoidal Hypophysectomy: A New Approach

Netzer, H. Roger;McCoy, E. Gordon

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050254003pmid: 6034652

Abstract THE PITUITARY FOSSA, because of its intimate anatomical relationship to the sphenoid sinus, lends itself well to a transsphenoidal surgical approach. The sphenoid sinus, in turn, has been reached by various transnasal and transsinus routes. The purpose of this article is to describe an operative technique for hypophysectomy which we feel is superior to previously described rhinologic approaches. The essentials of this operation consist of: (1) exposing the posterior septal area through a lateral rhinotomy, creating wide access to this area by fracturing the nasal wall laterally into a maxillary sinus fenestra; (2) entering the sphenoid through a short, midline, transseptal route; and (3) utilizing the wide field of exposure and the operating microscope for total hypophysectomy. The rhinologic approach to the pituitary fossa is desirable for the following problems: (1) biopsy or excision of certain pituitary tumors; (2) ablation of the pituitary gland for endocrine responsive metastatic breast cancer References 1. McCoy, G.: Cerebrospinal Rhinorrhea , Laryngoscope 73:1125-1157, 1963.Crossref 2. Hirsch, O.: Symptoms and Treatment of Pituitary Tumors , Arch Otolaryng 55:268-306, 1952.Crossref 3. Nager, F.R.: Paranasal Approach to Intra-Sellar Tumors , J Laryng 55:361-381, 1940.Crossref 4. Hamberger, C.A., et al: Transantrosphenoidal Hypophysectomy , Arch Otolaryng 74:2-8, 1961.Crossref 5. Trible, W., and Morse, A.: Transpalatal Hypophysectomy , Laryngoscope 75:1116, 1965.Crossref 6. MacBeth, R., and Hall, M.: Hypophysectomy as a Rhinological Procedure , Arch Otolaryng 75:440-450, 1962.Crossref
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Transethmosphenoidal Hypophysectomy

James, J. Angell

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050258004pmid: 6034653

Abstract IT IS NOW 14 years since the first total hypophysectomies were performed by Luft and Olivecrona by the transfrontal route. The operation was only rendered possible when cortisone became available for replacement therapy. It was not long after this that total hypophysectomy was also undertaken by various transsphenoidal routes, and the destruction of the gland was also attempted by the implantation of radioactive gold (198Au) and later by yttrium (90Y). For many years, controversy has raged over the advantages and disadvantages of the various surgical routes and irradiation techniques. After studying the various alternative techniques, I was satisfied that the transethmosphenoidal would prove the most successful in my hands for the following reasons. Transfrontal Approach.—Transfrontal craniotomy is an operation of considerable magnitude, with an operative mortality of 12% and a risk of ocular and olfactory nerve palsies. It is not possible to see into the depth of the sella, nor References 1. Forrest, A.P.M., and Stewart, H.J.: Bull Soc Intern Chir 23:224, 1964. 2. Fraser, R., et al: Lancet 1:382, 1959.Crossref 3. Notter, G.: Acta Radiol , (suppl 184) , p 1, 1959. 4. Bulbrook, R.D., and Greenwood, F.C.: Lancet 1:1154, 1960.Crossref 5. McCalister, A., and Welbourn, R.B.: Brit Med J , (June) , p 1669, 1962. 6. Hale, B.: Postgrad Med J 39:265, 1963.Crossref 7. Luft, R., and Olivecrona, H.: Experiences With Hypophysectomy in Man , J Neurosurg 10:301-316, 1953.Crossref
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Cryohypophysectomy and Transfrontosphenoidal Craniotomy in Pituitary Tumors

Rand, Robert W.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050267005pmid: 6034654

Abstract I WOULD like to emphasize a different approach to the pituitary gland and tumors which is not, as yet, popular with all neurosurgeons. Nevertheless, my general attitude about the art and practice of surgery is that one should be able to perform a given operation, in this instance hypophysectomy, in as many ways as possible. The particular approach can then be adapted to the particular clinical problem. American physicians are reluctant to recommend surgical hypophysectomy, and, consequently, I turned to a stereotaxic approach to the pituitary in 1959. Initially, radioactive90yttrium spheres were stereotaxically implanted into the pituitary gland for the treatment of metastatic mammary cancer. This technique of radiohypophysectomy, which has been used in England, France, and Sweden, accomplished quite satisfactory necrosis of the adenohypophysis. However, I experienced a 15% incidence of cerebrospinal rhinorrhea and meningitis and a 12% incidence of optic and oculomotor nerve palsies. Consequently, in References 1. Rand, R.W., et al: Stereotaxic Cryohypophysectomy , JAMA 189:255-259 ( (July) ) 1964.Crossref 2. Freshwater, D.B., et al: A Technique for Hypophysectomy , Calif Med 84:299-233 ( (April) ) 1956. 3. Rand, W.R., and Hanafee, W.N.: Cavernous Sinus Venography and Stereotaxic Cryohypophysectomy , J Neurosurg 26:521-526 ( (May) ) 1967.Crossref
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Studies in Human Hypophyseal Ablative Procedures

Van Buren, J. M.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050270006pmid: 4166517

Abstract THE PRESENT studies were made on a group of 50 patients studied in collaboration with the Branch of Endocrinology of the National Cancer Institute over a period of approximately two years. Nearly all of the patients were undertaken for the palliation of metastatic breast carcinoma. They were accepted only after oophorectomy in the premenopausal women who had reached their maximum benefit from palliative x-rays and endocrine therapy. In addition, a number of patients had had chemotherapy for their metastatic disease. It became evident rather early in the series that a beneficial response from oophorectomy or endocrine therapy was a rather uncertain indicator of the outcome of the pituitary ablation. Although many patients who had previously responded favorably to the treatment also responded favorably to pituitary ablation, others did not; and, it was soon found that certain patients who had not responded favorably before would respond with remission to pituitary ablation. References 1. Harris, G.W.: Oestrus Rhythm: Pseudopregnancy and the Pituitary Stalk in the Rat , J Physiol 111:347, 1950. 2. Harris, G.W., and Johnson, R.T.: Regeneration of the Hypophysial Portal Vessels, After Section of the Hypophysial Stalk, in the Monkey (Macacus rhesus) , Nature 165:819, 1950.Crossref 3. Donovan, B.T., and Harris, G.W.: The Effect of Pituitary Stalk Section on Light-Induced Oestrus in the Ferret , J Physiol 131:102, 1956. 4. Van Buren, J.M., and Bergenstal, D.M.: An Evaluation of Graded Hypophysectomy in Man , Cancer 13:155, 1960.Crossref 5. Tönnis, W., et al: Kann die Rachendachhypophyse eine vikariierende Funktion ausüben? Klin Wschr 32:912, 1954.Crossref 6. Melchionna, R.H., and Moore, R.A.: Pharyngeal Pituitary Gland , Amer J Path 14:763, 1938. 7. Maccubbin, D.A., and Van Buren, J.M.: A Quantitative Evaluation of Hypothalamic Degeneration and Its Relation to Diabetes Insipidus Following Interruption of the Human Hypophysial Stalk , Brain 86:443, 1963.Crossref 8. Rasmussen, A.T.: Proportions of Various Subdivisions of Normal Adult Human Hypophysis Cerebri and Relative Number of Different Types of Cells in Pars Distalis, With Biometric Evaluation of Age and Sex Differences and Special Consideration of Basophilic Invasion Into Infundibular Process , Proc Assoc Res Nerv Ment Dis Proc 17:118, 1938. 9. Floderus, S.: Untersuchungen über den Bau der menschlichen Hypophyse mit besonderer Berucksichtigung der quantitativen mikromorphologischen Verhältnisse , Acta Path Microbiol Scand 21( (suppl 53) ):1, 1944.
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Pituitary Ablation in Progressive Diabetic Retinopathy

Schimek, Robert A.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050276007pmid: 6034655

Abstract SINCE the advent of insulin therapy enabling survival of patients with diabetes, diabetic retinopathy has become and has remained one of the leading causes of incurable blindness. Both internists and ophthalmologists are haunted by the specter of diabetic retinopathy resulting in a hopelessly blind patient. Lack of effective treatment has prompted many therapeutic trials. Hypophysectomy for diabetic retinopathy is still controversial, although one decade has passed since the first report of its study in ophthalmic publications.1 Many ophthalmologists believe that pituitary ablation is still in the stage of therapeutic trial rather than a proved cure, however promising some recent reports may seem.2 A Modern Therapeutic Dilemma.—The very nature of diabetic retinopathy makes evaluation of an apparently beneficial therapeutic response difficult. Although the incidence and severity of retinopathy inexorably progress with the duration of the diabetes as a general trend, the condition often will wax and wane References 1. Schimek, R.A.: Hypophysectomy for Diabetic Retinopathy , Arch Ophthal 56:416-425 ( (Sept) ) 1956.Crossref 2. Field, R.A., et al: The Effect of Hypophyseal Stalk Section on Advancing Diabetic Retinopathy , Diabetes 1:465-469 ( (Nov) -Dec) 1962. 3. Davis, M.D.: Vitreous Contraction in Proliferative Diabetic Retinopathy , Arch Ophthal 74:741-751 ( (Dec) ) 1965.Crossref 4. Cogan, D.G., and Kuwabara, T.: Capillary Shunts in the Pathogenesis of Diabetic Retinopathy , Diabetes 12:293-300, 1963. 5. Friedenwald, J.S.: Jackson Memorial Lecture; New Approach to Some Problems of Retinal Vascular Disease , Trans Amer Acad Ophthal 53:73-87, 1948 6. Amer J Ophthal 32:487-498, 1949. 7. Becker, B., et al: The Adrenal Cortex and B-Vitamins in Diabetic Retinopathy , Diabetes 3:175-187 ( (May) -June) 1954. 8. Gordon, E.S.: " The Adrenal Cortex in Diabetes Mellitus ," in Christman, R.C. (ed.): Pituitary-Adrenal Function: A Symposium Organized by the Section of the Association , Baltimore: American Association for the Advancement of Science, 1951, pp 193-201. 9. Becker, B., et al: Vitamin B-12 Excretion and Diabetic Retinopathy , J Clin Nutr 1:417-422, 1953. 10. Gurin, S.: Panel Discussion: Normal Metabolism , Diabetes 4:184-190 ( (May) -June) 1955. 11. Fager, C.A.; Rees, S.B.; and Bradley, R.F.: Interim Report of a Combined Study Group of the Joslin Clinic and Leahy Clinic on Improvement of Diabetic Retinopathy by Ablation of the Hypophysis, read before the Harvey Cushing Society, New York, April 12, 1965.
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Preoperative and Postoperative Management of Hypophysectomy Patients

Berris, Robert F.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050284008pmid: 6071875

Abstract THE ANATOMIC relationships of the pituitary gland and the importance of the hypothalamic-pituitary portal system have been outlined in the preceding paper of this symposium. The following is a condensation of an extended paper on the subject of the physiology and preoperative and postoperative management of hypophysectomy. In the interest of brevity only so much of the physiology will be presented as is directly pertinent to the management of such cases and which may be unfamiliar to the nonendocrinologically oriented physician. Molecular biology will be largely avoided. For greater detail in this regard, the reader is referred to (a) the standard textbooks of endocrinology, (b) Ezrin's1 excellent review in the Ciba Clinical Symposia, and (c) the review "Hormones of the Anterior Pituitary Body" by Friesen and Astwood.2 Posterior Pituitary Function.—The posterior lobe of the pituitary gland is now known to be a storage organ for two chemically References 1. Ezrin, C.: The Pituitary Gland , CIBA Sympos 15:71-100 (no. (3) ) 1963. 2. Friesen, H., and Astwood, E.B.: Hormones of the Anterior Pituitary Body , New Eng Med J 272:1216-1222 ( (June 10) ), 1272-1276 (June 17), and 1328-1335 (June 24) 1965.Crossref
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Incus Autografts and Homografts in Rats

van den Broek, P.;Kuijpers, W.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050289009pmid: 4166518

Abstract RECONSTRUCTION of the middle-ear chain is an important part of tympanoplastic procedures. As the use of alloplastic prostheses in chronic ear surgery does not always lead to the desired improvement in hearing, and the prosthesis is often extruded, many surgeons prefer bone or cartilage if possible. The fate of cortical bone grafts in middle ear and bulla of experimental animals has been studied extensively,1,2 and from these studies we know these grafts revitalize. Transposition of the incus between malleus and stapes in dogs3 and between malleus and footplate in apes and cats,4 has shown different degrees of remodeling in the incus. In humans this transposition of the incus has been advocated by Hall and Rytzner,5 Guilford,6 and House,7 who obtained good functional results. Histologic examination in one of the reports5 left doubt about the vitality of the transposed ossicle. Kley and Draf8 References 1. Beck, C., and Franz, H.: Das Verhalten im Mittelohr implantierter auto- und homoioplastischer Knochenspäne in Tierexperiment , Arch Ohr Nas Kehlkopfheilk 179:111-122, 1961.Crossref 2. Guilford, F.R.; Shortreed, R.; and Halpert, B.: Implantation of Autogenous Bone and Cartilage Into Bullae of Dogs , Arch Otolaryng 84:144-147, 1966.Crossref 3. Guilford, F.R.; Shaker, E.F.; and Halpert, B.: Incus Repositioning in Dogs , Arch Otolaryng 84:316-319, 1966.Crossref 4. Stengl, T.A., and Hohman, A.: Experimental Incus Transposition , Arch Otolaryng 80:72-79, 1960.Crossref 5. Hall A., and Rytzner, C.: Vitality of Autotransplanted Ossicles , Acta Otolaryng , (suppl 158) , 335-340, 1960. 6. Guilford, F.R.: Repositioning of the Incus , Laryngoscope 75:236-242, 1965.Crossref 7. House, W.F., and Sheehy, J.L.: Functional Restoration in Tympanoplasty , Arch Otolaryng 78:304-309, 1963.Crossref 8. Kley, W., and Draf, W.: Histologische Untersuchungen über autotransplantierten Gehörknöchelchen und Knochenstücken in Mittelohr beim Menschen , Acta Otolaryng 59:593-603, 1965.Crossref 9. Wilson, D.F.; Pulec, J.L.; and v. Vliet, P.D.; Incus Homografts in Cats , Arch Otolaryng 83:554-559, 1966.Crossref 10. House, W.F.; Patterson, M.E.; and Linthicum, F.H., Jr.: Incus Homografts in Chronic Ear Surgery , Arch Otolaryng 84:148-153, 1966.Crossref 11. Linthicum, F.H., Jr.: Postoperative Temporal Bone Histopathology , Laryngoscope 76:1232-1241, 1966.Crossref 12. Heinen, J.H.; Dabbs, G.H.; and Mason, H.H.: The Experimental Production of Extopic Cartilage and Bone in the Muscles of Rabbits , J Bone Joint Surg 31:765-775, 1949. 13. Ham, A., and Gordon, S.: The Origin of Bone That Forms in Association With Cancellous Chips Transplanted Into Muscle , Brit J Plast Surg 51:154-160, 1952.Crossref
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Transplant of Incus Homograft in the Human

Hildyard, Victor H.

1967 Archives of Otolaryngology

doi: 10.1001/archotol.1967.00760050296010pmid: 6034656

Abstract IT HAS BEEN my experience that long-term results for improved hearing by using a plastic or other synthetic material to form a columella from the tympanic membrane to the oval window have been unsatisfactory. For cases in which there was no remnant of the ossicular chain, other than the footplate of the stapes, the use of a suitable columella that would approximate the results obtained by transposing the incus was indicated. The improvement in hearing obtained by transposing the incus with the tip of the short process on the oval window and the long process under the neck of the malleous has been satisfactory in 132 procedures performed in the past six years (Table 1). This paper presents the changes in hearing and the histopathologic changes of an incus homograft transplanted in the human ear during reconstructive surgery. A review of the literature did not reveal
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