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Biomedical subjects

T S Reeve

Publications and source records attributed to T S Reeve.

At least 19 recordsLinked to original sources
PubMed1992

Total thyroidectomy.

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History, 19th Century↗
PubMed1992

Total thyroidectomy: its role in the management of thyroid disease.

Of 7812 patients treated for thyroid disease in the Endocrine Surgical Unit at the Royal North Shore Hospital, 825 underwent total thyroidectomy as an initial procedure. One third of these patients (269) were operated on for malignancy and the remaining 556 were treated for benign conditions such as multinodular goitre (405), Graves' Disease (79) and thyroiditis (45). The rate of recurrent laryngeal nerve palsy was 0.5% while permanent hypoparathyroidism occurred in 0.6% of cases, the low complication rate being due to the technique of capsular dissection employed in the Unit. The number of total thyroidectomies performed as a percentage of all thyroid operations has risen from 4% in 1970 to more than 40% in 1990. The majority of this increase has been due to surgery for multinodular goitre where the proportion of patients treated by total thyroidectomy now exceeds 80%. A similar but smaller increase has been seen in an analysis of the New South Wales figures for all other public and private hospitals. It is concluded that the complication rate from total thyroidectomy can no longer be used to argue against its use as the definitive operation for malignant disease of the thyroid. Furthermore, in view of the risks of re-operative surgery, total thyroidectomy should be considered the operation of choice for most benign disease affecting the whole thyroid gland such as multinodular goitre, thyroiditis, and in a significant number of goitres affected by thyrotoxicosis.

Adolescent↗
PubMed1992

Total thyroidectomy: the technique of capsular dissection.

This paper describes the technique of total thyroidectomy using capsular dissection. Total thyroidectomy is a safe straightforward anatomical procedure in which meticulous dissection can provide protection to the parathyroid glands and to the recurrent laryngeal nerve. This protection is achieved by using capsular dissection, hugging the gland and dividing the tertiary branches (i.e. the third order of division) of the vessels while dissecting the parathyroid glands with their vascular pedicles free from the thyroid surface, with minimal exposure of the recurrent laryngeal nerve and disturbance of its blood supply. Total thyroidectomy removes all visible thyroid tissue although it is permissible to leave a very small remnant of tissue (less than a fraction of a gram) in the region of the ligament of Berry in order to protect the recurrent laryngeal nerve and the blood supply to the parathyroid glands. This technique ensures that the incidence of complications, including permanent hypoparathyroidism and recurrent laryngeal nerve palsy, is reduced to a minimum.

History, 20th Century↗
PubMed1992

Does Graves' disease or thyrotoxicosis affect the prognosis of thyroid cancer.

Twenty-one patients who underwent surgical treatment for thyrotoxicosis and who were found at operation to have thyroid cancer are presented. Sixteen had Graves' disease and 5 had toxic nodular goiter. The group with Graves' is compared with 110 euthyroid patients with thyroid cancer who underwent their initial surgery in the same time period and who were of the same age (+/- 1 yr) and sex as the patients with Graves' disease. None of the thyrotoxic patients died during follow-up of 2-24 yr or developed subsequent metastases. The 1 patient with a local lymph node metastasis has not shown evidence of recurrence. Hypoparathyroidism appeared as a complication in only 1 patient. The size of tumors in the patients with Graves' disease was significantly smaller than in the euthyroid group. The course of the disease in both the patients with Graves' disease and the thyrotoxic group as a whole was relatively benign. This series does not support the recent suggestions that thyroid cancer in patients with Graves' disease is more aggressive than in either patients with toxic nodular goiter or euthyroid subjects. Patients with Graves' disease and thyroid cancer should be treated identically to other patients with thyroid cancer. Therapy should consist of total thyroidectomy followed by a postoperative 131I scan. Residual tissue or metastases found on the scan should be ablated with 6 GBq 131I. The patient should receive a suppressive dose of T4.

Adult↗
PubMed1990

What rate of infusion of intravenous nutrition solution is required to stimulate uptake of amino acids by peripheral tissues in depleted patients?

We examined the effect of varying the quantities (0, 0.1, 0.2, 0.3, and 0.4 gN.kg-1.[day]-1) of nitrogen input on N balance, 3-methylhistidine (3MH) excretion, plasma amino acid concentration and the net flux of amino acids across the leg in depleted patients requiring parenteral nutrition. The calorie-to-nitrogen ratio was 140 to 1 (kcal:1 gN) and consequently the patients received varying amounts of calories (8, 14, 28, 42, and 56 kcal.kg-1.[day]-10. There was negative nitrogen balance and net loss of amino acids from the limb during fasting. An infusion of 0.2 gN.kg-1.[day]-1 of IVN reversed the net catabolic process and resulted in equilibrium of peripheral total amino acid flux and of tyrosine flux without a decrease in 3MH excretion. Net uptake of total amino acids and tyrosine in peripheral tissues was achieved with 0.4 gN.kg-1.[day]-1 and 56 kcal.kg-1.[day]-1. This was associated with a fivefold increase in 3MH excretion (p less than 0.01), indicating that net anabolism occurred with increased protein turnover. Fifty per cent of the amino acids taken up by peripheral tissues during infusions of 0.4 gN.kg-1.[day]-1 was due to the uptake of glutamate (Glu) and 20% was due to the uptake of branched chain amino acids (BCAA). Plasma Glu concentration, [Glu], did not increase with increasing IVN infusion, but BCAA concentrations did. Although the mean plasma [Glu] did not change with IVN infusion, there was an independent effect of plasma [Glu] (p less than 0.0001) and of N input (p less than 0.0001) on Glu flux, indicating that even at high infusion rates the maximal capacity of peripheral tissues to take up Glu had not been reached.

Amino Acids↗
PubMed1990

Fine needle biopsy of thyroid nodules: the importance of technique.

Fine needle biopsy (FNB) is the most accurate method available for the investigation of single thyroid nodules. The exact technique employed, however, varies considerably among clinicians: in our institution the incidence of 'inadequate' specimens produced ranges from only 13 to 62%, depending on the individual performing the biopsy. In a prospective in vivo study, a variety of biopsy techniques employing different gauge needles and differing numbers of passes with and without aspiration were assessed with respect to the quality of cytological specimen produced. Criteria assessed included the number of cells or sheets of cells, cell clumping, blood contamination, amount of colloid, and overall slide quality. Samples obtained with a 21 gauge needle without aspiration consistently gave best individual cell morphology. On the other hand, samples obtained with a 23 gauge needle with five aspirated passes through the nodule gave the highest yield of cells with an acceptable minimal increase in the degree of blood contamination and cell clumping. In order to achieve consistent yields from FNB of thyroid nodules, a combination of these two techniques is recommended.

Adult↗
PubMed1978

Preoperative parathyroid identification by ultrasonic scan.

A preliminary report of the use of ultrasonic scans to locate parathyroid tissue before neck exploration is presented. Three patients suffering from hyperparathyroidism had abnormal parathyroid tissue located before surgery. These findings were confirmed at operation. The role of ultrasonic scans of the neck before exploration is discussed.

Aged↗
PubMed1978

Ultrasonic visualization of breast cancer.

Ultrasonic examination of the breast with grey scale echography gives considerable information about the composition of the constituent tissues. This information alone is sometimes of major assistance in the management of the individual patient, particularly in young women with nodular breasts due to dysplastic changes. The method is complementary to the more commonly used visualization techniques and should be considered, particularly in young women, as the first imaging technique to examine palpable masses in the breast, prior to the utilization of ionizing radiation.

Adenocarcinoma, Scirrhous↗
PubMed1978

Parathyroid identification by methylene blue infusion.

A preoperative infusion of methylene blue was employed in 20 patients undergoing neck exploration for hyperparathyroidism. The dye was noted to stain adenomas and hyperplastic glands a deep purple-blue colour. Normal parathyroid tissue stained to a lesser extent or not at all. All unstained parathyroid tissue was normal histologically. Methylene blue infusion is a safe method of more rapidly identifying parathyroid tissue. Its preferential staining of abnormal parathyroid tissue can assist the surgeon in deciding the extent of his parathyroid excision.

Adenoma↗
PubMed1977

Detection and classification of liquid-filled masses in the breast by gray scale echography.

Gray scale ultrasonic visualization of the breast is a simple and safe technique for the detection of liquid-filled masses. Cysts and enlarged ducts as small as 2 mm in diameter can be reliably detected with a greater accuracy than is possible with any other imaging technique. The ultrasonic examination provides considerable information about the nature of the constituent tissues, and this information alone is often sufficient for a determination of the correct treatment.

Breast Diseases↗
PubMed1975

Postoperative complications of thyroidectomy: a comparison of two series at an interval of ten years.

A comparison is presented of the complications found in two series each consisting of 331 consecutive patients undergoing thyroidectomy in the same Unit ten years apart. The overall incidence of postoperative complications has been reduced, particularly in the group of patients having thyroidectomy for thyrotoxicosis following which it is now no greater than after thyroidectomy for benign non-toxic goitre. The techniques used to try to reduce the postoperative complication rate are discussed. The incidence of permenent recurrent laryngeal nerve palsy has been reduced to 0-3% and of permanent hypoparathyroidism to 1-2%. The overall incidence of complications causing permanent disability is now 3-9%.

Adolescent↗
PubMed1975

The sequelae inferior vena caval interruption.

Recurrent pulmonary emboli occurred in 26 of 85 patients (31%) after inferior vena caval interruption to prevent pulmonary emboli. Sequelae following this procedure included early problems associated with bleeding, venous thrombosis, the sequestration syndrome, and death. Late sequelae were recurrent episodes of venous thrombosis, the post-phlebitic syndrome and recurrent emboli. Inferior vena caval interruption is associated with significant continuing disability, and it fails to solve the problem it was designed to prevent.

Adult↗