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Biomedical subjects

C F Russell

Publications and source records attributed to C F Russell.

At least 37 records · Page 2Linked to original sources
PubMed1989

Thallium-technetium isotope subtraction scanning in primary hyperparathyroidism.

Between January 1983 and March 1986, 75 consecutive patients underwent cervical exploration for primary hyperparathyroidism. Each patient had a thallium-technetium subtraction isotope scan of the neck performed preoperatively. Of 71 patients with technically satisfactory scans, 68 came to 'first-time' neck exploration while three underwent reoperation for persistent hypercalcaemia. At primary cervical operation 53 of the 68 patients each had a solitary adenoma as the cause of their hyperparathyroidism. In 28 (53%) of these individuals the scintigram accurately predicted the site of the parathyroid tumour ('helpful' scans). The technique was 'unhelpful' in 17 patients (32%) with false-positive scans and in eight patients (15%) with false-negative scans. There was a highly significant difference between the median weight of adenomas removed from patients with helpful scans (1.05 g) and that of adenomas retrieved from individuals with unhelpful scans (0.47 g), (P less than 0.001). Since 1 January 1985 we have adopted a policy of 'scan-directed' unilateral neck exploration for patients with hyperparathyroidism on the basis of solitary adenoma and in whom the isotope scan was positive. The mean operating time for these patients (n = 18, mean operating time 1.24 h) was significantly shorter than that for patients with unhelpful scans (n = 14, mean operating time 1.55 h, P less than 0.01) who were submitted to standard bilateral cervical operation. Subtraction scanning was helpful, in terms of localization of enlarged parathyroid glands, in only three of eight patients with multigland hyperplasia. The investigation was of positive help in locating the adenoma in two of three individuals submitted to cervical re-exploration for persistent hyperparathyroidism.

Adenoma↗
PubMed1988

Cyclical Cushing's syndrome presenting as short stature in a boy with recurrent atrial myxomas and freckled skin pigmentation.

A young male patient demonstrated unusual features of Cushing's syndrome, atrial myxomas and freckled skin pigmentation. At 4.5 years of age he presented with intermittent swelling of his face and abdomen associated with weight gain and mild hypertension. A left atrial myxoma, suspected from routine physical examination, was surgically removed at 6.1 years of age. The initial mild symptoms clinically thought to be due to Cushing's syndrome, persisted intermittently without any consistent biochemical abnormality. At 10 years of age height velocity decreased and at 12 years early osteoporosis was observed radiologically. Repeated dexamethasone tests revealed a paradoxical increase in cortisol and corticotrophin from normal basal levels. Further investigation showed a cyclical pattern of hypercortisolism. The removal of a pituitary microadenoma failed to correct the features of Cushing's syndrome or prevent intermittent hypercortisolism. At 15.3 years a second left atrial myxoma was removed. This was followed by bilateral adrenalectomy. Histologically the features were consistent with primary pigmented nodular adrenocortical disease. This is the first patient described with cyclical Cushing's syndrome as part of this unusual complex of disorders.

Child, Preschool↗
PubMed1987

Perforated duodenal ulcer: which operation?

Between January 1968 and December 1977 a total of 230 patients with a perforated duodenal ulcer underwent emergency operation in the Royal Victoria Hospital. Simple suture closure of the perforation was carried out in 205, and in the remaining 25 a definitive ulcer procedure was performed in addition. Four patients died following operation, a mortality rate of 1.7%.During a mean follow-up period of 10.3 years at least 107 patients (52%) who had simple suture closure of their perforation developed further ulcer symptoms. Of these, seven re-perforated and a further 56 required elective definitive ulcer surgery. A strong case can be made for a definitive ulcer operation at the time of emergency surgery for a perforated chronic duodenal ulcer.

Adult↗
PubMed1986

Pancreatic polypeptide immunoreactivity in medullary carcinoma of the thyroid: identification and characterisation by radioimmunoassay, immunocytochemistry and high performance liquid chromatography.

Pancreatic polypeptide immunoreactivity has been identified in primary medullary carcinoma of thyroid using radioimmunoassay and immunocytochemistry and subsequently characterised by HPLC. Two region-specific PP antisera were used in the study; one C-terminal and one non-C-terminal. These antisera demonstrate variable cross-reactivity with the molecular species of PP identified in the tumours. The immunoreactive material in the tumours corresponded to human PP and not PYY or NPY on the basis of immunoreactivity and HPLC behaviour. It was identified in all patients with familial-type disease but not in the two sporadic cases examined. We propose that estimation of the PP content of medullary carcinoma of thyroid may be a useful means of differentiating familial and sporadic types.

Adult↗
PubMed1985

Meckel's diverticulum in the adult.

Meckel's diverticula were removed from 49 adult patients during a 15 year period. In 24 (49 per cent) of the patients the diverticulum was the cause of symptoms while in the remaining 25 it was an incidental finding at laparotomy. Of the symptomatic patients, 10 had acute inflammation of their diverticula, 8 presented with small bowel obstruction (in 4 cases due to fibrous bands) and 4 attended because of gross rectal bleeding; of the 2 remaining patients one was found to have intussusception of Meckel's diverticulum into the terminal ileum whilst the other had a nodule of calcified material lying within a partly gangrenous vitellointestinal duct. There was no operative mortality in the series. Heterotopic tissue was noted histologically in six Meckel's diverticula, all of which produced symptoms. The importance of considering a diagnosis of Meckel's diverticulum in the young adult presenting with acute small bowel obstruction or rectal bleeding is emphasized.

Adolescent↗
PubMed1983

The reasons for persistent hypercalcaemia after cervical exploration for presumed primary hyperparathyroidism.

Of 500 consecutive patients who underwent cervical exploration for presumed primary hyperparathyroidism, 461 (92.2 per cent) were cured, as judged by an immediate return of serum calcium levels to normal. Thirty-nine patients (7.8 per cent) had persistent hypercalcaemia after the initial operation. The clinical profiles, operative and pathologic findings, surgical procedures performed and subsequent management of these 39 patients were reviewed. At reevaluation, 4 patients were noted to have been cured of their hyperparathyroidism. Twenty-one patients had persistent hyperparathyroidism: in 6, all 4 parathyroid glands had not been identified at the initial operation and in 15, hypercalcaemia persisted after the identification of 4 glands. One patient had recurrent hyperparathyroidism after the removal of a 720 mg adenoma and the identification of 3 normal parathyroid glands. Nine patients had nonparathyroid causes for the hypercalcaemia: 2 had occult malignant neoplasms, 6 had benign familial hypocalciuric hypercalcaemia and 1 had immobilization hypercalcaemia. In 4 patients the reason for the persistent hypercalcaemia remained unclear. We suggest a schema that may be used as a guideline in the investigation and management of patients with persistent hypercalcaemia after primary neck exploration for presumed hyperparathyroidism.

Adenoma↗
PubMed1983

The surgical management of medullary thyroid carcinoma.

Medullary carcinoma of the thyroid may occur in three patient groups: multiple endocrine neoplasia, type 2b (MEN2b), MEN2a, and sporadic. The prognosis is best in MEN2a and worst in MEN2b. Multicentric disease occurs in approximately 90% of patients in the MEN groups and in 20% of the patients in the sporadic group. The minimal surgical procedure advocated is total thyroidectomy with dissection of the central compartment nodes. When neck dissection is performed, there appears to be no advantage in resecting the internal jugular vein or the sternomastoid muscle. Primary relatives of all patients with medullary carcinoma should be screened by measurement of plasma immunoreactive calcitonin to identify C-cell disease in a generally unsuspecting group/reservoir and because it results in earlier diagnosis, which leads to a less extensive surgical procedure and a higher percentage of patients with a disease-free state.

Adolescent↗
PubMed1982

Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient.

A group of 500 patients with a presumptive diagnosis of primary hyperparathyroidism (HPT) was operated upon at the Mayo Clinic between September 1974 and May 1980 using a standardized operative strategy. Clinical profiles, biochemical data, operative findings and pathological changes are reviewed. Of the 500 patients, 461 (92.2 per cent) were cured after primary cervical exploration. One patient died during the postoperative period, 1 had a permanent unilateral vocal cord paralysis and 10 (2 per cent) had protracted hypoparathyroidism. Owing to the continuing controversy regarding the appropriate therapeutic management of asymptomatic, uncomplicated and mild ('biochemical') primary HPT, we further evaluated this surgical experience by comparing the results of operation in two groups of patients: those with 'biochemical' HPT (serum calcium less than 11 mg/dl) and those with 'non-biochemical' HPT (symptomatic or complicated disease or serum calcium greater than 11 mg/dl). The cure rate in each patient group was greater than 90 per cent. A statistically significant increase in the incidence of negative cervical exploration (4 normal parathyroid glands identified and biopsied) was noted in the 'biochemical' group. However, parathyroid disease was found at operation in 92 per cent of these patients. We conclude that cervical exploration in all patients with primary HPT, including those with 'biochemical' disease only, is safe and that such an aggressive management policy is justified.

Adenoma↗
PubMed1982

Adrenalectomy: anterior or posterior approach?

The relative merits of the anterior and posterior approaches to the adrenal gland were assessed in a series of 103 patients with bilateral cortical hyperplasia or unilateral cortical adenoma (less than 25 g). In none of the patients was additional concomitant surgery planned. Sixty-four patients were operated on through the anterior and 39 through the posterior approach. Iatrogenic injury of the spleen necessitated splenectomy in 9 (18 percent) of 49 patients undergoing left adrenalectomy anteriorly. In 10 (26 percent) of 39 patients operated on posteriorly, the pleural cavity was entered. Perioperative blood requirement and postoperative morbidity were lower when the posterior approach was used. The hospital stay was significantly shorter after both unilateral and bilateral adrenalectomy when operation was done through the posterior approach. The results of this study lend strong support to a posterior lumbar approach for adrenalectomy for small benign adrenal cortical lesions.

Adenoma↗
PubMed1982

Adrenal surgery: trends during the seventies.

Surgical experience with adrenal disease from 1970 to 1979 was reviewed in 315 patients. The pathologic conditions that were encountered were hypercortisolism (74 patients), hyperaldosteronism (46 patients), adrenocortical carcinoma (35 patients), pheochromocytoma (77 patients), and nonfunctioning adenoma (47 patients). In addition, 5 patients with metastatic lesions, 14 with cysts, and 4 with myelolipoma were surgically treated. The accuracy of localizing adrenal lesions increased from about 50 percent to almost 100 percent during the decade studied. The increase was due mainly to the introduction of computerized tomography, the most important advance in the management of adrenal disease. The present study shows that adrenal surgery can be performed with low morbidity and mortality. Operative deaths were confined to patients with malignant disease or increased secretion of cortisol or catecholamines. Only patients with adrenocortical carcinoma (2 year survival probability, 34 percent) or hypercortisolism due to cortical hyperplasia (5 year survival probability, 76 percent) had significantly decreased survival.

Adrenal Gland Diseases↗
PubMed1982

Hyperfunctioning supernumerary parathyroid glands. An occasional cause of hyperparathyroidism.

It has become increasingly appreciated that, although rare, a supernumerary (fifth) parathyroid gland may be a cause of excess parathyroid hormone production. This review reports 15 patients, each of whom had hyperparathyroidism as a consequence of such a hyperfunctioning fifth gland. It is apparent that these patients are similar to the usual patients with primary hyperparathyroidism with respect to complications of the disease, type of pathology, and care after surgical excision of the abnormal parathyroid tissue. Significantly different, however, is the fact that the majority of these fifth-gland tumors were located in the mediastinum. The circumstances under which a supernumerary gland should be expected and the recommended surgical approach are reviewed.

Adult↗
PubMed1981

Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinotomy for removal.

Most hyperfunctioning parathyroid tumors situated in the mediastinum can be removed by means of a cervical approach. However, a few tumors, because of their location deep in the chest, require mediastinotomy for removal. These tumors are probably derived from parathyroid glands that have developed from the third branchial pouch. Between 1942 and 1980, 38 such tumors were removed at the Mayo Clinic, using a sternum-splitting procedure. With one exception, the patients had undergone previous parathyroid exploration, Almost all of the patients had significant complications of primary hyperparathyroidism (HPT). Thirty-seven patients (97%) were cured after removal of their mediastinal parathyroid tumors, but postoperative chest complications were encountered in eight patients (21%), and eight have permanent hypoparathyroidism. Six patients had selective arteriography, two had selective thyroid venous sampling and parathyroid hormone assay, and 13 had mediastinal computed tomography in an attempt to localize tumors before operation. The anatomic locations of the tumors at operation were variable, but the vast majority (68%) were in or near the thymus.

Adenoma↗
PubMedDate not supplied

Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach?

Thallium-Technetium isotope subtraction scanning was used routinely as a preoperative localization investigation in 90 patients with primary hyperparathyroidism who were submitted to "first-time" cervical exploration from 1985 to 1988. When the scintigram demonstrated a single focus of activity suggesting the site of a solitary parathyroid adenoma, a scan-directed exploration was carried out. If the tumor was found at the location suggested by the scan, it was then removed and the ipsilateral normal parathyroid was biopsied. The contralateral side of the neck was not explored in these patients. A total of 48 patients underwent unilateral cervical exploration while the remaining 42 individuals had a standard bilateral neck operation performed. The difference in operating times for patients who had a solitary adenoma and who underwent unilateral and bilateral neck exploration, respectively, was statistically highly significant (71 minutes versus 97 minutes, p less than 0.001). At mean follow-up of 16.8 months, no patient who had a unilateral neck exploration performed for solitary parathyroid adenoma demonstrated persistent or recurrent hypercalcemia.

Adenoma↗
PubMedDate not supplied

Median sternotomy for parathyroid adenoma.

Most mediastinal parathyroid tumours lie within the thymus gland and may be retrieved when cervical thymectomy is carried out in the course of neck exploration for primary hyperparathyroidism (HPT). We report 4 patients, each of whom required sternotomy for removal of a true mediastinal parathyroid adenoma. Subtraction isotope scintigraphy suggested the presence of a mediastinal tumour prior to cervical exploration in 2 individuals and prior to re-exploration in a third. When localisation before initial exploration for HPT suggests a parathyroid tumour within the chest, consideration should be given to proceeding to sternotomy, at first operation if a comprehensive neck exploration, including cervical thymectomy, fails to uncover the adenoma. Uniquely, one of our patients underwent sternotomy for HPT when 23 weeks pregnant.

Adenoma↗