Biomedical subjects
Publications and source records attributed to A D Barnes.
Two acalculous renal transplant patients, of more than 1,000 performed at this center, suffered early infarction and perforation of the gallbladder following operation. This rare complication may be related to both postoperative stress and the immunocompromising drugs given to renal transplant patients.
Midshaft femur fractures are not expected in the newborn, particularly with the currently increased cesarean section rate. Such injuries have occurred when the mother had uterine myomas or diabetes or when the fetus had intrauterine growth retardation or osteoporosis secondary to copper deficiency, but they can also occur in newborn infants with normal weights and healthy mothers.
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Two young men developed nephrotic syndrome associated with Hodgkin's lymphoma and progressive renal failure. After a short course of hemodialysis with blood transfusion, each received a cadaveric renal transplant. During the postoperative period, chemotherapy (MOPP) was given. No transplant rejection episodes were diagnosed. The patients, who live normal lives, have been in lymphoma remission for 12 and 22 months and have serum creatinine levels of 120 and 108 mumol/L 47 and 50 months posttransplant, respectively (Table 1).
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This paper describes some of the earlier experiences of parathyroid disease in Birmingham. It goes on to describe the experience of the disease in patients with and without renal failure treated by one surgeon over the past decade. It should be read in conjunction with a previous publication in the Annals (3). A careful neck exploration by a surgeon experienced in parathyroidectomy gives a high (92.3%) cure of all comers with primary hyperparathyroidism. The majority of failures are cases with familial disease. The surgical treatment of secondary hyperparathroidism in renal failure is more controversial. The author's preference for total parathyroidectomy and autotransplantation is explained.
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Acute renal allograft rupture is a well recognised though uncommon complication of transplantation. Previous reports suggest a close association with rejection and record a high incidence of graft loss and significant mortality. In a series of 11 consecutive allograft ruptures, no graft required removal at initial exploration and eight are still functioning with a mean follow-up of 20 months. This experience shows acute renal allograft rupture is a relatively benign complication and that conservative management leads to a satisfactory outcome in the majority of patients.
The uptake of 111In autologous platelets in transplanted kidneys was measured in 16 patients shortly after operation. Each patient was then observed for two years. When transplant radioactivity had increased, despite treatment for acute rejection, the kidney was ultimately lost because of rejection.
Ninety eight patients who underwent cervical exploration for primary hyperparathyroidism are reviewed. The detection of this condition in increasing numbers of patients, particularly those with minimal or no symptoms is confirmed. Initial exploration was successful in 92 cases using visual localisation with immediate frozen section examination of any presumed parathyroid tissue. The high incidence of solitary adenomata (84%) and low rate of recurrent hypercalcaemia support a "conservative" surgical approach as opposed to routine sub-total parathyroidectomy. The most common complication of surgery was hypocalcaemia, which is preventable by avoiding routine exhaustive exploration for, and unnecessary biopsy of, normal glands.
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The variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re-exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incision.
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