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Biomedical subjects

M P Stearns

Publications and source records attributed to M P Stearns.

At least 19 recordsLinked to original sources
PubMed2005

Methylene blue toxicity following infusion to localize parathyroid adenoma.

The parathyroid glands are small, inconspicuous, and variable in number, colour and position. Their identification is vital for excision of hyper-functioning glands and for preservation of normally functioning ones in patients undergoing thyroidectomy. Intravenous infusion of methylene blue at a dose of 7.5 mg/kg is commonly used to aid visualization of the parathyroid glands intra-operatively. Methylene blue is generally considered benign, and there are only two cases published in the literature reporting toxicity following intravenous infusion--such toxicity is a diagnosis of exclusion. We report a case of methylene blue toxicity resulting in expressive aphasia, confusion and disinhibition following infusion for parathyroid adenoma localization. The patient made a complete recovery over 48 hours. Methaemoglobinaemia was excluded as a cause. We suggest that the mechanism of toxicity was a direct effect of methylene blue, although an adverse interaction with serotonin re-uptake inhibitors could not be excluded. In keeping with the UK National Poisons Information Service recommendations, we have altered our practice and now use methylene blue at a dose not exceeding 4 mg/kg. This has not affected our success rate for identification of parathyroid glands. We report this case to highlight the rare occurrence of methylene blue toxicity when used at a dose of 7.5 mg/kg.

Adenoma↗
PubMed2004

Preoperative localization of parathyroid adenomas: ultrasonography, sestamibi scintigraphy, or both?

Minimal access techniques are increasingly used to remove parathyroid adenomas. Such surgery depends on accurate preoperative localization but the selection of imaging modality remains controversial. We have reviewed the accuracy of ultrasonography, sestamibi scintigraphy and their combination in 48 cases of primary hyperparathyroidism. Ultrasound had a sensitivity of 64.3% (95% confidence interval 44.1-81.4) and positive predictive value (PPV) of 100% (81.5-100) for correct lateralization. Sestamibi had a sensitivity of 83.3% (69.8-92.5) and PPV of 87.1% (73.7-95.1). The simple combination of ultrasound with sestamibi had a sensitivity of 82.1% (63.1-93.9) and a PPV of 92.0% (74.0-99.0): little different from sestamibi alone. However, if the sestamibi result was disregarded in favour of ultrasonography in discordant cases, the sensitivity reached 96.4% (81.7-99.9) and the PPV was 100% (87.2-100). These results were not dependant on a learning curve or the size of adenoma.

Adenoma↗
PubMed1995

Bleeding after tonsillectomy in severe von Willebrand's disease.

A case is reported of a HIV-positive patient with severe von Willebrand's disease describing the bleeding complications during and after tonsillectomy. This patient underwent surgery for asymmetrical tonsillar hypertrophy. The tonsils were spontaneously haemorrhaging and there therefore was a suspicion of neoplasia. Despite close cooperation between the ENT Department and the Haemophilia Centre, involving per-operative Factor VIII monitoring and replacement, the patient suffered both protracted primary and secondary haemorrhages. We report this as a cautionary tale as our previous experience with mild to moderate haemophilia has been uncomplicated, but on this occasion there was massive haemorrhage. We feel that tonsillectomy should not be undertaken in a patient with a severe bleeding disorder without an absolute indicate.

Adult↗
PubMed1994

Orbital complications of sinusitis: avoid delays in diagnosis.

Orbital cellulitis and abscess formation are uncommon complications of sinusitis. Early diagnosis and treatment are important to prevent blindness and intracranial complications. We present four consecutive cases referred over 2 years which demonstrate how diagnostic delays may occur and suggest a protocol to avoid similar delays.

Abscess↗
PubMed1990

Oncocytoma of the larynx.

A case of oncocytoma of the larynx is presented. These lesions are rarely found in the larynx, and have been more commonly described in the salivary and thyroid glands. The histopathological diagnosis is often difficult and the light microscopy can be unreliable for oncocytic lesions. For a more accurate definition of these tumours, the use of histochemical stains together with electron microscopy are advocated. With adequate surgery, the prognosis is excellent, and tumours are unlikely to recur. This paper discusses the management of a patient with a benign oncocytoma of the true vocal cord, and presents a review of the world literature.

Adenoma↗
PubMed1990

Haemangiosarcoma of the maxillary antrum.

Angiosarcomas are extremely rare in the head and neck and the histological diagnosis is often difficult. We present a case of a haemangiosarcoma of the maxillary antrum in a 33 year old male. The histological diagnosis and subsequent management are discussed.

Adult↗
PubMed1987

Reconstruction of the middle third of mandible.

The radial forearm flap is established as a suitable method of providing bone with soft tissue lining or skin cover in reconstruction of the mandible. A simple and effective method of modelling the radius to provide the appropriate contour to the anterior arch of the mandible is described.

Humans↗
PubMed1983

The effect of irradiation on nerve regeneration.

Nerve grafts were performed on rat sciatic nerves at varying intervals after the graft bed had been irradiated. The functional repair was assessed electrophysiologically. Five groups of animals were used with the pre-operative interval varying from 1 to 8 weeks. No difference was found in the success of the nerve graft in any group.

Action Potentials↗
PubMed1982

The effect of irradiation on nerve grafting.

The purpose of this study was to investigate the effect of pre-operative radiotherapy on nerve grafting, using the rat sciatic nerve as an experimental model. Two groups of 10 rats were used, one group irradiated, the other not. In each rat a 5 mm section of one sciatic nerve was excised then replaced and sutured into position. Nerve regeneration was investigated by expressing the area of the mass action potential in the regenerated nerve as a percentage of the mass action potential in the contralateral intact nerve. A significant difference (P less than 0.01) in nerve regeneration was found between the irradiated and non-irradiated animals. In the irradiated group only two animals achieved more than 20% nerve fibre regeneration whilst in the non-irradiated group all but two animals achieved greater than 20% regeneration. These results suggest that pre-operative irradiation has an adverse effect on nerve regeneration.

Animals↗