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Robert C. Greenwood and Harold C. Voris

This case is reported because the unusual clinical course and pathological aspects make it important not only in the differential diagnosis and treatment of surgical conditions of the spinal cord but also as a rare manifestation of an already uncommon grave disease. Blastomycosis usually takes either a cutaneous or a systemic course. The cutaneous type tends to heal, whereas the systemic type is characterized by chronicity, and widespread infection in the lungs, subcutaneous tissues, bone, and internal organs. Prognosis in this type is extremely grave

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George Ehni and Nylene E. Eckles

for exophthalmos of Graves' disease by interventions above and within the sella. Two patients appear to have had simple interruption of the pituitary stalk, at least one of whom had a mechanical barrier to revascularization of portal vessels interposed. These authors believed that hypopituitarism following section of the stalk and cauterization within the sella is of more rapid onset and becomes more severe than following interruption of the stalk alone. Edelstyn et al. 9 reported trying to solve the problem of inadequacy of either surgical removal or any form of

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Bronson S. Ray

suppression of PBI and I 131 uptake, while two patients with Graves' disease had incomplete regression of hyperthyroidism and persistent high levels of the iodine studies These are new and as yet unaccountable observations made possible principally by studies in man. With investigations now in process we may expect to learn more of this heretofore unsuspected property of the thyroid to function autonomously. There is precedent for the neurosurgeon's interest in abnormal thyroid states in that one of the progenitors of American neurosurgery, Charles Frazier, came to

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Orbital Hemangiopericytoma

Review of the Literature and Report of Four Cases

David N. Brown, Collin S. MacCarty and Edward H. Soule

fields; and Hertel exophthalmometric measurements of O.D. 23 mm. and O.S. 17 mm. Neurologic findings were normal. The patient was thought to have a hyperophthalmopathy of Graves' disease. Clinically, she was euthyroid; a small, firm thyroid was palpable. The basal metabolic rate was +2 per cent, and proteinbound iodine measured 5.7 µg. per 100 ml. of serum; further laboratory results were noncontributory. Roentgenograms of the skull and optic canals were negative. Treatment with Lugol's solution was prescribed and the patient was dismissed. The patient returned in

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Raymond M. Taniguchi, John A. Goree and Guy L. Odom

misdiagnosed as cases of Horton's headache, proptosis or sixth nerve palsy of undetermined etiology, unilateral Graves' disease, and orbital tumor. The principal cause of misdiagnosis has been the absence of a bruit. These fistulas have also been overlooked during cerebral angiography, or confused with orbital or nasopharyngeal angiomas and neoplasms. All 11 of the cases reported here were of spontaneous onset. Three patients were men over 50 years of age. Six of the eight women were postmenopausal, ranging in age from 47 to 71 years. The other two women were in the

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Kathleen Graze, Mark E. Molitch and Kalmon Post

. In-vivo and in-vitro studies. Ann Intern Med 79 : 679 – 683 , 1973 Singer I, Rotenberg D: Demeclocycline-induced nephrogenic diabetes insipidus. In-vivo and in-vitro studies. Ann Intern Med 79: 679–683, 1973 13. Temple R , Berman M , Carlson HE , et al : The use of lithium in Graves' disease. Mayo Clin Proc 47 : 872 – 878 , 1972 Temple R, Berman M, Carlson HE, et al: The use of lithium in Graves' disease. Mayo Clin Proc 47: 872–878, 1972 14. White MG , Fetner CD

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Gerald J. Harris and Frederick A. Jakobiec

characteristics of orbital cavernous hemangioma were found to be rounded or ovoid contour, some internal echoes, and fair to good sound transmission. 1 The differential diagnosis by this modality included lymphangioma when the regular contour of the lesion could not be discerned, meningioma when the tumor could not be distinguished from the optic nerve, and Graves' disease when the lesion could not be distinguished from the extraocular muscles, implying enlargement of the muscles. The CT scan characteristics included rounded or ovoid contour, internal heterogeneity, and

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Charles F. Abboud and Edward R. Laws Jr.

-lactotropic tumor, but rarely to concomitant separate somatotropic and lactotropic tumors. It may also be related to hypothalamic-stalk dysfunction resulting from suprasellar extension of the pituitary tumor causing acromegaly. Thyroid disorders are common in acromegaly. Benign nontoxic multinodular goiter is the most frequent disorder. Hyperthyroidism, when present, is usually due to associated toxic nodular goiter or, rarely, to associated Graves' disease. Very rarely, however, hyperthyroidism may result from excessive TSH produced by the pituitary tumor. It is obviously very

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Joseph C. Maroon and John S. Kennerdell

Literature In 1889, Krönlein 10 first described an osteoplastic lateral orbitotomy approach to the retro-orbital space for tumors. This lateral approach was subsequently used by Dollinger, 3 specifically for palliation of the optic neuropathy of Graves' disease. Since then, ophthalmologists, otolaryngologists, and neurosurgeons have all devised various operations for orbital decompression in Graves' disease. In 1930, Hirsch and Urbanek 6 described a transantral removal of the floor of the orbit for decompression of malignant exophthalmos. This bone removal alone

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Stephen A. Hill, James M. Falko, Charles B. Wilson and William E. Hunt

H yperthyroidism resulting from a thyrotrophin (TSH)-secreting pituitary tumor is rare. We describe four patients with the biochemical features that provide a preoperative diagnosis. As in Graves' disease, total serum thyroxine (T 4 ), unbound serum thyroxine (free T 4 ), triiodothyronine (T 3 ) as measured by radioimmunoassay, and radioactive iodine uptake tests were consistently elevated. However, at a time when elevated circulating thyroxine should have suppressed secretion of TSH, serum levels were inappropriately elevated in all patients. Stimulation