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Seventy‐nine patients underwent subtotal or total adrenalectomy for pituitary‐dependent Cushing's syndrome (1953–1980); 76 survived the operation and 75 were followed for 1 to 27 (mean 11) years. Pigmentation, plasma ACTH, and sellar X‐rays were assessed at intervals. Pigmentation developed in 37 (5 before and 32 after operation), most frequently after total adrenalectomy. The sella was definitely enlarged in 6 of 65 patients before the operation and in 14 of 65 after it. Enlargement was more common in pigmented than in non‐pigmented patients. The plasma ACTH concentration rose after adrenalectomy. It was significantly higher in pigmented than in non‐pigmented patients. It was also higher after total than after subtotal adrenalectomy. Pituitary tumors were confirmed histologically in 15 patients. The tumors presented at the same time as the Cushing's syndrome in 8 and after adrenalectomy in 7. They were malignant and fatal in 6. Pigmentation, present in 11 of these patients, developed only after adrenalectomy. In 9 other patients with benign lesions and 21 with clinically probable but histologically unconfirmed tumors, 7 were treated by hypophysectomy with or without irradiation (4 cured, 3 improved), and 4 by irradiation alone: external 3, internal 1 (all improved).

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An association between colorectal cancer and previous peptic ulcer surgery is reported. In a prospective screening study, 100 asymptomatic patients (80 men and 20 women) who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema, colonoscopy and gallbladder ultrasonography. Control data were obtained from forensic autopsy subjects. The incidence of neoplasms greater than or equal to 1.0 cm in the vagotomized group was 14 per cent (11 adenomas, 3 carcinomas) and 3 per cent in controls (P = 0.01). Duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography. The mean percentage of cholic (CA), chenodeoxycholic (CDCA), deoxycholic (DCA) and lithocholic (LCA) acids in the bile of vagotomized patients was 32.3, 45.6, 20.7 and 1.4 per cent respectively compared with 45.3, 36.2, 17.9 and 0.7 per cent respectively in controls. The increased proportions of CDCA and LCA and decreased proportions of CA in the duodenal bile of vagotomized patients were significant (P less than 0.001; P = 0.02; P = 0.007). Abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotomy.