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Biomedical subjects

C A Wang

Publications and source records attributed to C A Wang.

At least 55 records · Page 3Linked to original sources
PubMed1985

Malignant lymphoma of the thyroid gland: a clinical and pathologic study of twenty cases.

Among 20 patients with malignant lymphoma of the thyroid gland, the mean age at diagnosis was 63 years and the male to female ratio was 1:6. All patients had a firm, rapidly enlarging neck mass. In 90% of the patients the mass had been present for less than 1 year; in 40%, for less than 1 month. Approximately half of the patients tested had hypothyroidism; three fourths had elevated antithyroid antibodies. There was one nodular lymphoma. The remaining 17 cases available for review were diffuse. Thyroid lobectomy was performed in seven patients, limited excision in eight, and needle biopsy alone in five. External irradiation was administered in 11 cases (55%). Chemotherapy was used alone in one patient (5%) and in combination with radiotherapy in eight (40%). Six patients (30%) were alive without evidence of recurrent disease at follow-up ranging from 1 to 12 years. Eleven patients had died of lymphoma, all but one dying within 1 year. One patient died of other causes and two were lost to follow-up study. There was no appreciable effect of patient age or sex, lymphoma histology, or extent of surgical resection on survival. Treatment of choice for primary lymphoma of the thyroid gland appears to be external irradiation or chemotherapy, alone or in combination. The role of surgery is limited to making a tissue diagnosis of lymphoma, unless the tumor is completely intrathyroidal.

Adolescent↗
PubMed1984

Management of asymptomatic hyperparathyroidism.

From January 1, 1971, to December 31, 1982, 242 patients with uncomplicated biochemical or asymptomatic hyperparathyroidism underwent operative therapy at the Massachusetts General Hospital. They represent 36.1 percent of the 670 total operative cases during this period. Before 1971, from 1941 to 1970, there were only 33 hyperparathyroid patients with asymptomatic hyperparathyroidism who underwent surgery. The initial surgical procedures included 88 unilateral and 134 bilateral cervical explorations. There were 19 patients who underwent reexploration, including 15 referrals and 4 patients who had their primary operation at the Massachusetts General Hospital. There were no deaths, no recurrent nerve injuries, and only one patient with protracted but temporary postoperative hypocalcemia. Four patients (1.7 percent) had persistent hypercalcemia and therefore, must be considered treatment failures. The procedure resulted in normocalcemia in 238 of the patients (98.3 percent). The mean serum calcium level decreased from a preoperative value of 11.1 to 8.9 mg/100 ml the serum phosphorus level increased from 2.8 to 3.9 mg/100 ml postoperatively. Pathologic examination revealed 201 adenomas (83.1 percent), 39 hyperplasias (16.1 percent), 2 patients with normal glands (0.8 percent), and no carcinomas. The size of the abnormal glands appeared to correlate with the degree of hypercalcemia. Patients with marked hypercalcemia generally had a large gland that was more easily identified than the gland patients who had milder disease in whom it was smaller, harder to locate, and more difficult to distinguish pathologically from a normal gland. In general, patients with milder disease (serum calcium less than 11 mg/100 ml) should be followed expectantly. In some of these patients, there is doubtless progressive exacerbation of hypercalcemia, increases in the parathyroid hormone level, osteopenia, or renal insufficiency which ultimately requires surgical intervention. In others, there is apparently severe biochemical, asymptomatic hyperparathyroidism as manifested by a serum calcium level greater than 11 mg/100 ml, an increased parathyroid hormone level, increased 24 hour urinary calcium excretion greater than 150 mg, progressive loss of bone mass, or deterioration of renal function. These latter patients should be operated on without delay. For patients who risk the long-term complications of hyperparathyroidism and menopausal patients who are potentially threatened by postmenopausal osteoporosis, surgery is likely to be beneficial. For those whose compliance with therapy or follow-up poses a significant logistic problem, surgical therapy is often the best solution.

Adenoma↗
PubMed1984

Parathyroid surgery in patients with renal failure.

A subtotal parathyroidectomy was performed in 32 patients with hyperparathyroidism and renal dysfunction. Minimal long-term sequelae were observed [two patients with recurrent hyperparathyroidism (6.2%), one patient with persistent hypoparathyroidism (3.1%)]. This experience is compared with reports in the literature advocating total parathyroidectomy and autotransplantation. A subtotal parathyroidectomy remains the preferred approach at this institution. Patients with elevated alkaline phosphatase levels before surgery should be monitored carefully for early postoperative hypocalcemia. The low incidence (3.2%) of hyperparathyroidism observed in patients following successful renal transplantation indicates that hypercalcemic allograft recipients should be observed for at least 4 months before contemplating surgical intervention.

Adolescent↗
PubMed1982

Surgical management of hyperparathyroidism due to primary hyperplasia.

A series of 104 consecutive patients treated at the Massachusetts General Hospital between 1933 and 1978 for primary hyperplasia was reviewed. Early in this period (1933-1958) nine patients were treated by what was the considered subtotal resection (five with clear cell and four with chief cell hyperplasia). Hypercalcemia persisted in four cases; three from inadequate resection and one (case 170) associated with a fifth gland in the mediastinum that was removed at a second stage operation. Later (1959-1978), adequate subtotal resection, leaving 30 to 50 mg of viable hyperplastic tissue, was performed in 28 patients (7 with clear cell and 21 with chief cell hyperplasia). The operation was successful in 27 patients (96%). In one patient (case 442) subtotal resection failed, and hypercalcemia recurred, requiring a second operation. Sixty-seven patients in this series had excision of one, two, or three (but not more than three) glands. Of these 21 (31%) had persistent hypercalcemia after operation and required further surgery. Transient hypocalcemia occurred in 40 patients, permanent hypocalcemia in two. This study shows that subtotal resection, leaving 30 to 50 mg of viable tissue, is the surgical treatment of choice for primary parathyroid hyperplasia. It is effective in the great majority of patients. We have not found total parathyroidectomy with autotransplantation necessary and believe that it should be reserved only for selected cases.

Adult↗
PubMed1981

Surgery of hyperparathyroidism: a conservative approach.

The extent of surgery in the treatment of primary hyperparathyroidism should be based on the pathologic entity of the disease. In neoplasia (either the common adenoma or the rare carcinoma), excision of the diseases parathyroid will generally suffice to cure the disease, but in primary hyperplasia, the removal of all the diseased glands except for a small amount of glandular tissue is required. The pathologic diagnosis of primary hyperparathyroidism can usually be made by a macroscopic assessment of the parathyroid. It is further delineated by the density test and confirmed by Sudan fat-frozen section examination.

Densitometry↗
PubMed1979

Hyperparathyroid crisis: clinical and pathologic studies of 14 patients.

A study is presented of 14 patients with hyperparathyroid crisis treated at the Massachusetts General Hospital between 1964 and 1978. These patients showed diverse clinical manifestations that were indistinguishable from those in patients with pseudohyperparathyroidism. Their symptoms varied from progressive fatigue, malaise, and weakness to those related to the gastrointestinal and urinary tracts. The one biochemical alteration commonly found among these patients was the rapid increase in the serum calcium. There was a concomitant rise in the BUN in 50% of the patients and in the creatinine in 80%. The diagnosis was established by an elevated immunoreactive parathyroid hormone (PTH) level in all eight patients (100%) who had the radioimmunoassay; by the presence of subperiosteal resorption of the phalanges in six of the eight patients (75%); and in three of four patients (75%) by the loss of the lamina dura of the teeth. The 12 patients who had surgery all survived; the two who did not died. Thirteen patients (93%) had a neoplasm--an adenoma in 12 and a carcinoma in one. One patient had hyperplasia (7%). Nine patients (64%) received hypocalcemic drug therapy. The serum calcium temporarily fell to 12 mg/100 ml in five patients (56%) but failed to budge in four (44%). Simultaneous treatment with saline infusion, furosemide and with hypocalcemic drugs over a prolonged period compounded the difficulty at operation by increasing interstitial edema. Our findings from this study show prompt surgical intervention as the ideal treatment for hyperparathyroid crisis, preferably, within 72 hours of the acute onset of symptoms.

Adenoma↗
PubMed1978

A density test for the intraoperative differentiation of parathyroid hyperplasia from neoplasia.

A simple, instant, and reliable test called the Density Test, based on the difference in density between the normal and the diseased parathyroid tissue, was performed intraoperatively in 73 patients with primary hyperparathyroidism. Whereas the normal parathyroid tissue floated, the diseased tissue invariably sank in a mannitol solution with a density range between 1.049 and 1.069. With the aid of this test, a diagnosis of adenoma was made in 66 patients and of primary hyperplasia in the remaining seven. In every case the diagnosis was subsequently confirmed. Forty-two of the 66 patients with an adenoma (64%) had a unilateral exploration of the neck. The Density Test saved these patients from an unnecessary contralateral exploration by the finding of an adenoma and a normal second gland in the same side of the neck. These data show that the Density Test is useful in the intraoperative diagnosis of a diseased from a normal parathyroid tissue. Tissue that sinks within the density range of 1.049 and 1.069 is without exception diseased and should therefore be either partially or completely excised even if the gland is of average size or only of slight enlargement. If it does not sink, it is virtually certain to be normal and should be spared. The Density Test provides a valuable clue in the differentiation of primary parathyroid hyperplasia from neoplasia.

Adenoma↗