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Biomedical subjects

C C Reading

Publications and source records attributed to C C Reading.

49 records · Page 3Linked to original sources
PubMed1987

Medullary thyroid carcinoma: role of high-resolution US.

Medullary thyroid carcinoma accounts for 10% of thyroid malignancies. Accurate determination of the extent of disease is important because surgery is required for initial treatment and recurrence. High-resolution (10-MHz) ultrasonography (US) of the neck was used to study 15 patients with medullary thyroid carcinoma; nine of the 15 had undergone thyroidectomy but had biochemical evidence of tumor recurrence. Metastatic cervical lymph nodes were detected with US in all 12 patients who had metastatic nodes at surgery, although these nodes were palpable in only four. Punctate bright echogenic foci were seen within some of the nodes in nine of the 12 patients (75%). Similar bright echogenic foci were seen within the primary intrathyroid tumor in five of the six patients who had not yet undergone thyroidectomy (83%). Pathologically, these foci correlated with deposits of calcium surrounded by amyloid, which is characteristic of medullary thyroid carcinoma. US is useful for the detection of nonpalpable recurrence of cervical metastatic lymph nodes, and because it is noninvasive and relatively inexpensive, it should be the first imaging investigation performed after thyroidectomy.

Adult↗
PubMed1986

Untreated rupture of the tunica albuginea.

A patient with untreated rupture of the tunica albuginea underwent surgical exploration 6 weeks after acute scrotal trauma. A layer of epithelium had grown across the bulging seminiferous tubules, and no further surgical repair was necessary. This spontaneous repair phenomenon has not previously been reported pictorially in the human testis. The recommended treatment of testicular rupture is surgical exploration and repair.

Adult↗
PubMed1986

Parathyroid carcinoma: high-frequency sonographic features.

The authors reviewed the features on high-frequency (10 MHz), realtime sonograms of parathyroid carcinoma in eight patients to identify characteristics that could preoperatively distinguish malignant from benign lesions. The mean diameter of the eight carcinomas was 2.4 cm. They were typically ovoid or round and had a lobulated contour. The carcinomas were predominantly hypoechoic relative to the adjacent thyroid, but two of the eight contained both hypoechoic and hyperechoic regions, and three contained cystic spaces. Two carcinomas were grossly invasive on ultrasonographic (US) examination, although seven were proved histologically to be invasive. High-resolution US provides a noninvasive means to localize primary and locally recurrent parathyroid carcinomas preoperatively but fails to distinguish carcinomas from large adenomas reliably, except in cases with extensive invasion of adjacent structures.

Adult↗
PubMed1986

Benign pancreatic insulinoma: preoperative and intraoperative sonographic localization.

Twenty-nine patients with surgically proved benign pancreatic insulinoma were studied by preoperative or intraoperative sonography. Twenty-five patients had solitary pancreatic tumors; four had multiple tumors. Six of the patients with solitary insulinomas and one of the patients with multiple insulinomas had undergone previous unsuccessful exploration. Preoperative sonography was performed in 24 patients with solitary insulinomas, and 15 (63%) were localized. Intraoperative sonography was performed in 22 patients with solitary insulinomas, and 19 (86%) were visualized without having been previously located by palpation. Four of these visible solitary tumors (18%) were not detected by palpation at surgery. All the solitary insulinomas were detected with the combination of palpation and intraoperative sonography. In each of the six patients with solitary insulinoma who had undergone previous surgery, the tumor was visible with intraoperative sonography, which also demonstrated nonpalpable insulinomas in two of the four patients with multiple tumors. Preoperative real-time sonography is a sensitive, noninvasive, inexpensive method for localization of insulinoma. Intraoperative high-frequency sonography is a highly sensitive method for the detection of insulinoma. Intraoperative sonography is also valuable to determine the relationship of the insulinoma to pancreatic and bile ducts and thereby facilitate safe enucleation.

Adenoma, Islet Cell↗
PubMed1985

Postoperative parathyroid high-frequency sonography: evaluation of persistent or recurrent hyperparathyroidism.

Sixty consecutive postoperative patients with recurrent or persistent hyperparathyroidism were scanned before reoperation using high-frequency (10 MHz) real-time sonography. The sonograms were interpreted prospectively, and the results correlated with subsequent surgical findings to determine the diagnostic accuracy of this technique in the localization of enlarged parathyroid glands. A total of 59 abnormal glands were found in 51 patients at operation: 45 in the neck and 14 in the mediastinum. Sonography identified 37 of the 45 cervical glands for a sensitivity of 82% in the neck. The mediastinum cannot be evaluated by sonography due to the bony thoracic cage, although if the mediastinal glands are included, the overall sensitivity was 63%. In the 14 patients with negative neck explorations but positive mediastinal explorations, sonography was negative in 12 patients, but false-positives were suspected in two patients, yielding a specificity of 86% in the neck. High-frequency sonography is a sensitive, rapid, and noninvasive technique for localizing enlarged cervical parathyroid glands in patients with recurrent or persistent hyperparathyroidism.

Adolescent↗
PubMed1982

High-resolution parathyroid sonography.

A total of 165 consecutive patients with suspected primary hyperparthyroidism was scanned preoperatively using high-resolution real-time sonography. The sensitivity of the procedure was 69% and the specificity 94% in the localization of individually enlarged parathyroid glands. In the subgroup of 21 patients undergoing reoperation in the neck, the sensitivity and specificity were 80% and 92%, respectively. In patients with a single parathyroid adenoma, there was a close but not linear correlation between sonographic diagnostic accuracy and the size of the adenoma, which in turn was directly related to the serum calcium and immunoreactive parathyroid hormone levels. High-resolution sonography has become the procedure of choice in our institution for the preoperative localization of enlarged parathyroid glands in the neck.

Adenoma↗
PubMedDate not supplied

Solitary thyroid nodule. Comparison between palpation and ultrasonography.

OBJECTIVE: To determine the accuracy of clinical palpation in the diagnosis of solitary thyroid nodule in comparison with ultrasonographic findings. METHODS: From a computerized database of 1774 patients with the diagnosis of nodular thyroid disease made from January 1990 through December 1991 at our institution, we retrieved and reviewed the medical records of the 193 patients who underwent ultrasonography of the thyroid (42 patients with multinodular glands on palpation were excluded). Nodules were categorized as "solitary" or "dominant nodule of a multinodular gland." Concordance rates were measured between results of palpation and ultrasonographic findings. RESULTS: Of 151 patients included in the study, 78 had solitary nodules on ultrasonography and 73 had multiple nodules. Of those with multiple nodules, 49 had two nodules and 24 had three or more nodules. Of clinically palpable nodules, 89% were 1 cm or greater in diameter. In 72% of the patients with multiple nodules, the other nodules not identified on palpation were less than 1 cm in diameter. The overall concordance rate between the size of the solitary nodule or the dominant nodule in a multinodular gland estimated with clinical palpation and the actual size seen on ultrasonography was 72%. The relationship between multiple nodules and malignancy was not statistically significant. CONCLUSIONS: Our results suggest that (1) a palpable solitary nodule represents a multinodular gland in about 50% of patients, (2) clinical palpation is less sensitive than thyroid ultrasonography in identifying multiple nodules, and (3) palpation is reliable only if a nodule is at least 1 cm in diameter. We recommend that small, occult (impalpable) thyroid nodules not be considered clinically important; they do not warrant further evaluation unless ultrasonographic features suggest malignancy or the nodule increases in size.

Adult↗