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E C Skinner

Publications and source records attributed to E C Skinner.

6 recordsLinked to original sources

Technique of left adrenalectomy for autotransplantation to the caudate nucleus in Parkinson's disease.

Autotransplantation of the adrenal medulla to the caudate nucleus is a new neurosurgical treatment under investigation for severe Parkinson's disease. The success of the procedure is reliant partly on the ability of the urologist to remove the adrenal gland safely and atraumatically with minimal morbidity. We describe our technique using a posterior 12th rib approach, which is extrapleural and extraperitoneal. In the initial 10 patients there was no significant morbidity from the operation and all patients were discharged from the hospital within 3 to 7 days postoperatively. The importance of using a no touch technique in mobilizing the gland is emphasized, since any hemorrhage within the adrenal medulla may make it impossible to recover the tissue for stereotactic implantation. Hemorrhage occurred in 1 of our patients, who was elderly and obese. The technique described allows for adequate exposure while maintaining acceptably low morbidity from the procedure.

Adrenal Medulla

Radical cystectomy in the elderly patient.

A total of 77 patients 65 or more years old underwent radical cystectomy with urinary diversion for invasive bladder cancer during a 10-year interval. The preoperative medical condition of the patients, operative mortality and morbidity, and preliminary survival data are reviewed by age group. Two-thirds of the patients had previous medical or surgical problems that increased the surgical risk. The over-all mortality rate was 3.9 per cent. Early complications occurred in 31 per cent of the patients, with an increased risk of complication associated with previous illness and major pelvic surgery, and preoperative radiation therapy. The complication rate was not related directly to age, with patients 65 to 69 and more than 75 years old having lower rates than those 70 to 74 years old. The 3-year survival rate free of disease ranged from 58 per cent in the youngest group to 39 per cent in the oldest group, which is comparable to survival statistics for younger patients undergoing cystectomy. Only 5 patients have died of intercurrent illness, while 20 have died of metastatic disease.

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