Implementing guidelines about colorectal cancer: a national survey of target groups.
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Australia↗
Biomedical subjects
T Reeve
Publications and source records attributed to T Reeve.
Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient.
Surgery of the thyroid takes place in an area of complicated anatomy and in which a number of vital physiologic functions and special senses are controlled. Thyroidectomy rarely is associated with mortality; but unless the surgeon performing it is well trained in operative surgery and is knowledgeable of the gland and its function, pathology, and anatomy, excellent results cannot be achieved. Failure to observe cardinal surgical principles may result in legal difficulties, which can be avoided. It is well to observe the principles and avoid problems. We address this issue herein.
Humans↗
Multinodular goitre presenting as a clinical single nodule: how effective is hemithyroidectomy?
BACKGROUND: Patients who present with a single thyroid nodule that requires surgery will generally undergo hemithyroidectomy. If, however, the subsequent histological examination shows unsuspected multinodular change, there is a risk of recurrence in the remain ing lobe. The aim of this study was to determine the clinical outcome in patients who have had a hemithyroidectomy for a single thyroid nodule that was shown on subsequent histopathological examination to be part of a multinodular goitre. METHODS: A survey was undertaken of patients who were identified from a thyroid surgery database with the following criteria: (i) hemithyroidectomy for clinical single nodule; and (ii) multinodular change on histopathology. Main outcome measures were clinical recurrence rate, the frequency of further thyroid surgery, and the efficacy of thyroxine treatment on recurrence. RESULTS: In the 229 patients studied, the clinical recurrence rate was 12%. Fourteen of the 28 patients with recurrence required further surgery. Thyroxine therapy did not influence the recurrence rate. CONCLUSION: When surgery for a clinically benign single thyroid nodule is indicated, hemithyroidectomy is an adequate surgical procedure in cases where the single nodule is subsequently found to be part of a multinodular goitre. Such patients can be reassured that the chance of clinical recurrence is low. Thyroxine replacement therapy appears not to prevent recurrence.
Adolescent↗
Riedel's thyroiditis: treatment with tamoxifen.
BACKGROUND: Riedel's thyroiditis is an often disabling disease with clinical and histologic similarity to several other fibrous inflammatory disorders. Surgical treatment alone is often unsatisfactory in permanently alleviating airway compression, dysphagia, neck immobility, pain, or chronic fatigue syndrome. Investigation of drugs shown to be of benefit in the treatment of related fibrous disorders in which hormonal factors or inflammatory deregulation appear to be important is indicated. Tamoxifen has not been previously used in the treatment of Riedel's thyroiditis. METHODS: Four patients with clinical and histologic diagnoses of Riedel's thyroiditis were evaluated before and after treatment with tamoxifen. Each had progressive symptomatic disease of 3 to 16 years' duration despite one or more surgical procedures and steroid therapy. Subjective improvement was noted in all cases, and objective changes were confirmed by periodic physical and computed tomographic examinations. RESULTS: Patients have been monitored for 1 to 4 years with subjective improvement in 100% and objective disease regression ranging from 50% to 100% in all patients. One patient had complete regression within 6 months, and another had more than 50% regression within 3 months. All have returned to predisease activity levels. There were no significant side effects of the therapy. CONCLUSIONS: Tamoxifen has proved to be the most effective drug therapy available for managing Riedel's thyroiditis. Our studies suggest that this is unrelated to antiestrogen activity. Tamoxifen's effectiveness may be caused by a mechanism by which it stimulates the release of transforming growth factor-beta, which may inhibit the fibroblastic proliferation characteristic of Riedel's thyroiditis.
Adult↗
Longitudinal changes in forearm bone mineral content in primary hyperparathyroidism.
Forearm bone mineral content was measured in 28 patients with primary hyperparathyroidism before and 1 year after successful parathyroidectomy. The forearm bone mineral content rose from a mean value of 1.068 to 1.092 g/cm (P less than 0.05, paired t-test). Those patients with the lower initial values had the largest rise. In an additional study, the forearm bone mineral content was measured in 10 women over the age of 40 years (mean age 58.6 +/- 7.9SD years) with hyperparathyroidism before and for 2 years after successful parathyroidectomy and compared with the forearm bone mineral content measured over 2 years in 12 women (mean age 56.3 +/- 5.5SD years) with continuing hyperparathyroidism and with the forearm bone mineral content of 12 eucalcemic control women (mean age 58.8 +/- 8.2SD years), also measured over 2 years. The parathyroidectomized group gained bone, whereas the ongoing hyperparathyroid group and the eucalcemic control group lost bone. The difference between the parathyroidectomized group and the ongoing hyperparathyroid group was significant after 2 years (P less than 0.05). The percentage loss of forearm bone mineral in the eucalcemic control subjects was not significantly different from the percentage loss of forearm bone mineral in the ongoing hyperparathyroid group, although the initial mean bone mineral content in the eucalcemic group was significantly higher than in the ongoing hyperparathyroid group, suggesting that a possible determinant of bone mineral loss in women in this age group is the initial bone mineral content.
Adult↗
Near-total gastric necrosis caused by acute gastric dilatation.
Gastric dilatation caused by psychogenic polyphagia or bulimia may, under extreme circumstances, progress to total gastric necrosis. We have described a patient in whom acute abdominal symptoms and signs developed while he was receiving psychiatric treatment. Laparotomy showed massive gastric dilatation with near-total infarction. Total gastrectomy with cervical esophagostomy, feeding and decompressing jejunostomies, and wide drainage of the gastric bed were done. After staged reconstruction, recovery was uneventful.
Adult↗
Effects of experimental diabetes, uremia, and malnutrition on wound healing.
The strength of linear wounds was studied in normal and diabetic rats in the first 8 wk after wounding. The strength of wounds from diabetic animals was found to be reduced compared with normal controls but could be improved by insulin treatment, especially when excellent metabolic control was achieved. There appeared to be both quantitative and qualitative defects in the formation of wound tissues in diabetic animals, because wound strength was not normalized when the thinner skin of diabetic animals was taken into consideration. This was different from the findings in rats with renal failure or malnutrition: in these two conditions, wound strength appeared reduced but was normalized when adjusted for skin thickness. Increased activity of aldose reductase did not appear to be an important factor in the impairment of wound healing in diabetes, because wound strength was not corrected by treatment with sorbinil, an aldose reductase inhibitor. The precise mechanism of abnormal wound strength in diabetes remains to be studied further, but careful control of diabetes, maintenance of nutrition, and treatment of systemic illness are important factors in the promotion of wound healing.
Animals↗
The prevention and reversibility of tissue non-enzymatic glycosylation in diabetes.
The time course of non-enzymatic glycosylation (NEG) of liver, kidney, tail collagen, and haemoglobin was studied in diabetic rats. Increased NEG of liver, kidney, and collagen was detectable within 4 weeks of diabetes. The abnormal NEG of liver, kidney, and haemoglobin present after 4 weeks of untreated diabetes could be normalized by 4-8 weeks of intensive insulin therapy given by continuous subcutaneous infusion. However, the same treatment was ineffective in reversing the abnormal NEG and thermal stability of tail collagen. The differences in the development and reversibility of these tissue changes may be due to different tissue turnover rates. Insulin therapy, given from the onset of diabetes, was effective in preventing the development of collagen abnormalities. This suggests that early and vigorous treatment of diabetes is necessary to prevent collagen changes which are potentially irreversible.
Animals↗
Abnormalities of granulation tissue and collagen formation in experimental diabetes, uraemia and malnutrition.
The formation of granulation tissue and collagen was studied in rats made diabetic with streptozotocin. Granulation tissue was harvested from the inside of steelmesh cylinders implanted in the back of diabetic and control animals. Four weeks after implantation there was a reduction in the quantity of granulation tissue and its collagen content in diabetic animals compared to controls. Rats with renal failure or malnutrition but no diabetes also formed less granulation tissue but in these animals the content of collagen in the granulation tissue was normal. These results suggest that the decrease of collagen, but not granulation tissue, in diabetes is a relatively specific phenomenon which was not due to the toxic effects of streptozotocin as the changes were prevented by insulin treatment. The hydroxyproline/proline ratio of diabetic collagen was found to be normal, excluding defective hydroxylation of proline as an important factor in the reduction of collagen in diabetes. Treatment with an aldose reductase inhibitor did not prevent the abnormalities of granulation tissue and collagen in diabetes, making it unlikely that increased activity of this enzyme played an important pathogenetic role. The observed reduction of granulation tissue mass and collagen content in diabetes may be important factors in the impairment of wound healing in diabetes.
Aldehyde Reductase↗
Duplex scanning of the portal vein and portasystemic shunts.
This article describes the preliminary findings of a Duplex ultrasound technique that enables the patency of the portal circulation and portosystemic shunt patency to be determined. In addition, the equipment allows the noninvasive measurement of quantitative rates of blood flow in these vessels. Portal vein flow was 952 +/- 273 ml/min in 10 normal subjects after an overnight fast and increased by 50% at 30 minutes in response to a standard 660-calorie liquid meal. Thirteen portosystemic shunts were scanned, and hemodynamic information was obtained from 10. Three of the four patients who had a Warren shunt performed 3 to 4 years earlier had portal vein occlusion. There is evidence of an increase in flow through the Warren shunt on feeding, suggesting a hemodynamic connection to the mesenteric side of the circulation. The apparatus, technique of examination, and the characteristics and difficulties with particular types of shunts are described.
Adult↗
The effects of cyclooxygenase and lipoxygenase inhibitors on the collagen abnormalities of diabetic rats.
The importance of cyclooxygenase and lipoxygenase pathways in the determination of collagen abnormalities in diabetes was investigated. Pharmacological agents with antiprostaglandin activity, such as indomethacin, naproxen, and aspirin, were able to prevent the rise in thermal rupture time of tail collagen in diabetic rats. Paracetamol was without effect. The action of indomethacin on diabetic collagen was abolished by concurrent administration of sodium benoxaprofen, an inhibitor of lipoxygenase, to the diabetic rats. Collagen abnormalities in diabetes may be regulated by a balance of the cyclooxygenase and lipoxygenase pathways. Antiprostaglandin agents may have a role in the prevention of some diabetic complications.
Acetaminophen↗
Thyroglobulin may be undetectable in the serum of patients with metastatic disease secondary to differentiated thyroid carcinoma. Follow-up of differentiated thyroid carcinoma.
To assess the value of serum thyroglobulin (Tg) levels in the follow-up of differentiated thyroid carcinoma after ablative therapy simultaneous Tg estimations and radioiodine (131I) scans were performed on patients during an 18-month follow-up period. In this study, 287 scans were performed on 200 patients who were not receiving Thyroxine (T4) replacement at the time, i.e., off T4. Wherever possible, Tg was also estimated while the patient was receiving T4. All sera were screened for Tg autoantibodies which were detected on 67 occasions in 44 patients (22%). Of the 220 sera without Tg autoantibodies (156 patients), 17 were accompanied by scan evidence of functioning thyroid tissue, although Tg was undetectable (less than 5 micrograms/l) either on or off T4. Serum Tg was only detectable off T4 in a further five patients (six scans) who simultaneously had scan evidence of functioning thyroid tissue. In seven patients the finding of detectable Tg preceded scan evidence of recurrence. Thus, serum Tg is useful in the follow-up of differentiated thyroid cancer after ablative therapy. However, some patients with recurrence or metastasis will be missed if Tg alone is relied on, particularly if thyroxine treatment is continued.
Adenocarcinoma↗
Pneumatic perforation of the colon during colonoscopy. Is the hypermobile right colon a risk factor?
Perforation of the colon by pneumatic injury during colonoscopy is a rare complication. Intraoperative observations of a patient who developed massive cecal distention, pneumatosis coli and severe pneumoperitoneum during colonoscopy suggest that an isolated, air-trapping colonic segment is a factor in the mechanism of such injury. The possibility that a poorly fixed, hypermobile cecum and right colon predispose to such injury by air insufflation during colonoscopy is discussed.
Air↗
The effect of salicylates on nonenzymatic glycosylation and thermal stability of collagen in diabetic rats.
The effects of glucose on the nonenzymatic glycosylation and thermal rupture time of rat tail collagen were examined by (1) in vitro incubation of collagen fibers in glucose and (2) in vivo in diabetic rats. In vitro, glucose caused a dose-dependent rise in both nonenzymatic glycosylation and thermal rupture time and there was a good correlation between these two parameters (r = 0.68, P less than 0.0001). Aspirin, a known inhibitor of nonenzymatic glycosylation, was effective in preventing the glucose-induced rise in nonenzymatic glycosylation and thermal rupture time when present at concentrations of 0.78, 1.56, and 3.12 mM. Sodium salicylate at concentrations of 1.56 and 3.12 mM was also effective. In vivo, the nonenzymatic glycosylation and thermal rupture time of collagen fibers were both increased by 2-3-fold in rats with streptozotocin-induced diabetes of 4 wk duration. Aspirin or sodium salicylate treatment for 4 wk (240 mg/kg/day) from the onset of diabetes was able to prevent the rise in thermal rupture time without affecting nonenzymatic glycosylation of collagen or glycosylated hemoglobin levels. Aspirin or sodium salicylate treatment did not have detectable effect on properties of collagen in normal rats. The in vitro findings are consistent with the hypothesis that nonenzymatic glycosylation leads to the increased thermal stability of collagen fibers. The significance of nonenzymatic glycosylation in vivo is less certain, as thermal rupture time can be altered independently. The action of aspirin and sodium salicylate in vivo suggests new therapeutic options in the prevention and treatment of diabetic complications.
Animals↗
The thermal stability of collagen in diabetic rats: correlation with severity of diabetes and non-enzymatic glycosylation.
The thermal stability of collagen fibres from rat tail tendon was studied in both normal and diabetic rats. Results were correlated with the age of the animals, glycosylated haemoglobin level and the degree of non-enzymatic glycosylation of the collagen. Age was found to be the most important single determinant of the thermal rupture time of collagen fibres (r = 0,87, p less than 0.005). Thermal rupture time was also increased in diabetes and showed good correlation with glycosylated haemoglobin (r = 0.69, p less than 0.005) and non-enzymatic glycosylation of collagen (r = 0.51, p less than 0.005). The correlation of glycosylated haemoglobin level and thermal rupture time was significant, independent of age and non-enzymatic glycosylation of collagen. Experiments in vitro showed that incubation of collagen fibres with glucose increased the thermal stability of collagen. These results demonstrated an independent effect of severity of diabetes on the physical properties of collagen. The role of non-enzymatic glycosylation in causing the changes in collagen properties in diabetes remains to be fully elucidated.
Aging↗
Parathyroid sonography: a useful aid to preoperative localization.
Parathyroid sonography was used to identify 19 of 23 glands enlarged to over 5 mm in transverse diameter in 22 patients presenting with hyperparathyroidism, both primary and secondary. The false positive and false negative rates were 5 percent and 6 percent, respectively.
Adenoma↗
A comparative evaluation of a case of cystosarcoma phylloides: ultrasound, xeroradiography and thermography.
The results of xeroradiography, thermography, and ultrasonic gray scale echography in a case of cystosarcoma phylloides are presented. Echography better described the lesion than the other techniques. Gray scale echography displays the infrastructure of the breast tissues and differentiates between types of soft tissue.
Breast Neoplasms↗
Ultrasonic Grey scale visualization of the thyroid gland.
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Adenoma↗