Oesophageal resection in patients with oesophageal speech.

some patients was lateralised (fig 1) or could be seen as a narrow cleft. A tumour in the remaining tissue in a partially empty sella could also be defined, allowing us to identify four tumours in partially empty sellae and in one patient (case 12) to remove the tumour selectively, leaving the normal pituitary tissue and function undisturbed. Other features of value that were clearly visualised included bony erosion, lateral and suprasellar spread of the tumour (case 7), and exclusion of an aneurysm eroding into the pituitary fossa. Such precision has now rendered the expensive and distressing technique of air encephalography and metrizamide contrast procedures practically obsolete in our practice. Computed tomography enables the clinician to assess more accurately the possible likelihood of dangerous pituitary expansion in any future pregnancy-for instance, one patient (case 7) had a normal-sized fossa radiologically but showed a 4 mm suprasellar extension that could have produced visual impairment had the patient become pregnant. The clinician can now assess the feasibility of selective tumour removal or ablation and obtain a non-invasive follow-up. Although it appeared that the tests using metoclopramide and thyrotrophin-releasing hormone correctly identified tumour in most cases, the number of false-positives in those without visible tumours tended to negate their value. A tumour may however, become visible in those sellae with no visible microadenoma at present, and so a definite answer on the validity of dynamic tests must be qualified and indeed may never be resolved, for indefinite follow-up would be required. Certainly hormonal studies could not clearly identify full from empty sella. The fourth-generation CT scanners are thus a major advance in the understanding of disease of the sella in those with hyperprolactinaemia be it from tumourous causes or other conditions.