SUMMARY Twenty-five patients with dysphagia caused by neurological disorders, mainly motor neurone disease, underwent cricopharyngeal myotomy. Nineteen patients showed slight to dramatic improvement of swallowing for variable periods of time. There were five postoperative deaths. The results indicate that this simple procedure is of benefit to a substantial proportion of patients with neurological causes of dysphagia.
Fourteen patients with Cushing's disease treated by trans-sphenoidal hypophysectomy between 1962 and 1975 were reviewed in 1983. Complete ablation had been attempted. There were no surgical deaths and one episode of bacterial meningitis. Two patients required a second operation for a cerebrospinal fluid leak. There have been three late deaths from unrelated causes. All patients had a biochemical remission of their Cushing's disease postoperatively and no relapse has been recorded. Most patients need some hormone replacement but residual pituitary function and sella radiography have remained stable. This treatment seems satisfactory and the evidence implies a pituitary aetiology of the syndrome.
This study is based on a survey of the patients suffering from facial paralysis examined by me in the E.N.T. department of the United Birmingham Hospitals during a two-year period 1954 to 1956. The aims of the investigation were to seek criteria which will give guidance on the probability of spontaneous recovery in idiopathic facial paralysis and to assess the value of present methods of treatment. Material and Methods Of the 107 patients (54 male, 53 female) examined, 56 were affected on the right, 49 on the left, and 2 bilaterally. Their ages ranged from 5 to 75 years, the highest incidence being in the 30-40 age-group. All the palsies were of lower-motor-neurone type, and so in a sense could be described as cases of Bell's palsy; for in 1821 Bell distinguished between " paralysis which proceeds from the brain, and that affection of the muscles of the face when from a less alarming cause they have lost the controlling influence of the respiratory (i.e., facial) nerve." However, the term Bell's palsy is nowadays reserved for those cases of peripheral facial palsy in which there is no obvious cause such as injury, infection, or new growth (Cawthorne, 1951). Preliminary investigations established pathological causes in 10 patients. They were: (a) chronic mastoid infection (three patients); (b) intratemporal epidermoid of the type described by Jefferson and Smalley (1938) (two patients); (c) fracture involving the temporal bone (two patients); (d) sarcoidosis (one patient with bilateral paralysis); (e) acute middle-ear infection (one patient); (f) brain-stem glioma, which presented originally as a nuclear lesion (one patient). These are listed for completeness and are not discussed further.
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